Abstract
Objectives: The effect of different modes of immunosuppressive therapy in autoimmune inflammatory rheumatic diseases (AIRDs) remains unclear. We investigated the impact of immunosuppressive therapies on humoral and cellular responses after two-dose vaccination.
Methods: Patients with rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis treated with TNFi, IL-17i (biological disease-modifying antirheumatic drugs, b-DMARDs), Janus-kinase inhibitors (JAKi) (targeted synthetic, ts-DMARD) or methotrexate (MTX) (conventional synthetic DMARD, csDMARD) alone or in combination were included. Almost all patients received mRNA-based vaccine, four patients had a heterologous scheme. Neutralising capacity and levels of IgG against SARS-CoV-2 spike-protein were evaluated together with quantification of activation markers on T-cells and their production of key cytokines 4 weeks after first and second vaccination.
Results: 92 patients were included, median age 50 years, 50% female, 33.7% receiving TNFi, 26.1% IL-17i, 26.1% JAKi (all alone or in combination with MTX), 14.1% received MTX only. Although after first vaccination only 37.8% patients presented neutralising antibodies, the majority (94.5%) developed these after the second vaccination. Patients on IL17i developed the highest titres compared with the other modes of action. Co-administration of MTX led to lower, even if not significant, titres compared with b/tsDMARD monotherapy. Neutralising antibodies correlated well with IgG titres against SARS-CoV-2 spike-protein. T-cell immunity revealed similar frequencies of activated T-cells and cytokine profiles across therapies.
Conclusions: Even after insufficient seroconversion for neutralising antibodies and IgG against SARS-CoV-2 spike-protein in patients with AIRDs on different medications, a second vaccination covered almost all patients regardless of DMARDs therapy, with better outcomes in those on IL-17i. However, no difference of bDMARD/tsDMARD or csDMARD therapy was found on the cellular immune response.
Keywords: Autoimmune Diseases; COVID-19; T-Lymphocyte subsets; Vaccination.
【저자키워드】 COVID-19, vaccination., Autoimmune diseases, T-lymphocyte subsets, 【초록키워드】 SARS-CoV-2, IgG, vaccination, therapy, antibody, Cellular immune response, Neutralising Antibodies, drugs, cytokine, outcome, medications, rheumatoid arthritis, Seroconversion, neutralising antibody, female, Patient, spike-protein, Autoimmune, T-cell, methotrexate, inhibitor, monotherapy, quantification, spondyloarthritis, cytokine profile, psoriatic arthritis, Heterologous, Therapies, immunosuppressive therapy, T-cell immunity, cellular response, marker, Combination, Frequency, Inflammatory, immunosuppressive, humoral, rheumatic disease, T-lymphocyte, Activation, not significant, second vaccination, median age, no difference, titre, first vaccination, mRNA-based vaccine, csDMARD, highest, investigated, evaluated, receiving, treated, activated, majority, correlated, MTX, 【제목키워드】 drug, COVID-19 vaccination, Patient, Autoimmune, cellular response, Inflammatory, humoral, rheumatic disease,