Abstract
BACKGROUNDLimited information is available on the impact of immunosuppressants on COVID-19 vaccination in patients with immune-mediated inflammatory diseases (IMID).METHODSThis observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, or psoriatic disease, with or without maintenance immunosuppressive therapies. Ab and T cell responses to SARS-CoV-2, including neutralization against SARS-CoV-2 variants, were determined before and after 1 and 2 vaccine doses.RESULTSWe prospectively followed 150 subjects, 26 healthy controls, 9 patients with IMID on no treatment, 44 on anti-TNF, 16 on anti-TNF with methotrexate/azathioprine (MTX/AZA), 10 on anti-IL-23, 28 on anti-IL-12/23, 9 on anti-IL-17, and 8 on MTX/AZA. Ab and T cell responses to SARS-CoV-2 were detected in all participants, increasing from dose 1 to dose 2 and declining 3 months later, with greater attrition in patients with IMID compared with healthy controls. Ab levels and neutralization efficacy against variants of concern were substantially lower in anti-TNF-treated patients than in healthy controls and were undetectable against Omicron by 3 months after dose 2.CONCLUSIONSOur findings support the need for a third dose of the mRNA vaccine and for continued monitoring of immunity in these patient groups.FUNDINGFunded by a donation from Juan and Stefania Speck and by Canadian Institutes of Health (CIHR)/COVID-Immunity Task Force (CITF) grants VR-1 172711 and VS1-175545 (to THW and ACG), CIHR FDN-143250 (to THW), GA2-177716 (to VC, ACG, and THW), and GA1-177703 (to ACG) and the CIHR rapid response network to SARS-CoV-2 variants, CoVaRR-Net (to ACG).
Keywords: Adaptive immunity; Autoimmune diseases; COVID-19; Immunology; Immunotherapy.
【저자키워드】 COVID-19, immunology, Adaptive immunity, Autoimmune diseases, immunotherapy., 【초록키워드】 Treatment, immunology, Inflammatory diseases, SARS-CoV-2, Arthritis, Efficacy, Vaccine, immunogenicity, Immunity, mRNA vaccine, neutralization, Immunotherapy, variants of concern, omicron, immunosuppressants, variants, rheumatoid arthritis, Inflammatory bowel disease, T cell, COVID-19 vaccination, SARS-CoV-2 variants, Patient, methotrexate, Autoimmune diseases, information, disease, T cell response, attrition, Immunosuppressant, ankylosing spondylitis, dose, rapid response, donation, Task Force, immunosuppressive therapies, Support, Observational cohort study, Participants, Immune-mediated inflammatory diseases, azathioprine, anti-TNF, All participants, Adult patients, healthy control, healthy controls, force, spondylitis, Immune-mediated inflammatory disease, Juan, greater, examined, subjects, declining, Speck, undetectable, 【제목키워드】 SARS-CoV-2, Immunity, Patient, Immune-mediated inflammatory disease,