Absent antibody production following COVID19 vaccination with mRNA in patients under immunosuppressive treatments

Wagner, Alexandra; Jasińska, Joanna; Tomosel, Elena; Zielinski, Christoph; Wiedermann, Ursula

doi:10.1016/j.vaccine.2021.10.068

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…In contrast with previous studies, our findings may be due to the use of fewer or lower doses of immunosuppressive drugs. Nevertheless, in agreement with other studies in highly immunosuppressed populations, 28 , 29 , 31 a therapy combined with prednisone and another immunosuppressive drug resulted in an almost 6 times higher risk of not developing antibodies against spike protein.…”

Section: Discussionsupporting

confidence: 91%

“…This lack of efficacy seems to be more evident in patients on rituximab, fingolimod, or calcineurine inhibitors. 28,29 For this reason, concerns have been raised in recent scientific literature about the lack of efficacy of the usual vaccination schemes in immunosuppressed patients. 30 Specifically in neurologic disorders, a study performed in multiple sclerosis on different immunosuppressant treatment scheme patients assessing both humoral and cellular Flu-like symptoms (chills, myalgia, and fatigue), n (%) 4 (4) 7 ( 7) 11…”

Section: Discussionmentioning

confidence: 99%

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Immune Response and Safety of SARS-CoV-2 mRNA-1273 Vaccine in Patients With Myasthenia Gravis

Reyes‐Leiva

López-Contreras

Moga

et al. 2022

Neurol Neuroimmunol Neuroinflamm

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Background and ObjectivesEvidence regarding the safety and efficacy of messenger RNA (mRNA) vaccines in patients with myasthenia gravis (MG) after immunosuppressive therapies is scarce. Our aim is to determine whether the mRNA-1273 vaccine is safe and able to induce humoral and cellular responses in patients with MG.MethodsWe performed an observational, longitudinal, prospective study including 100 patients with MG of a referral center for MG in our country, conducted from April 2021 to November 2021 during the vaccination campaign. The mRNA-1273 vaccine was scheduled for all participants. Blood samples were collected before vaccination and 3 months after a second dose. Clinical changes in MG were measured using the MG activities of daily life score at baseline and 1 week after the first and second doses. A surveillance of all symptoms of coronavirus disease 2019 (COVID-19) was conducted throughout the study. Humoral and cellular immune responses after vaccination were assessed using a spike-antibody ELISA and interferon gamma release assay in plasma. The primary outcomes were clinically significant changes in MG symptoms after vaccination, adverse events (AEs), and seroconversion and T-cell immune response rates.ResultsNinety-nine patients completed the full vaccination schedule, and 98 had 2 blood samples taken. A statistically significant worsening of symptoms was identified after the first and second doses of the mRNA-1273 vaccine, but this was not clinically relevant. Mild AEs occurred in 14 patients after the first dose and in 21 patients after the second dose. Eighty-seven patients developed a humoral response and 72 patients showed a T-cell response after vaccination. A combined therapy with prednisone and other immunosuppressive drugs correlated with a lower seroconversion ratio (OR = 5.97, 95% CI 1.46–24.09, p = 0.015) and a lower T-cell response ratio (OR = 2.83, 95% CI 1.13–7.13, p = 0.024).DiscussionOur findings indicate that the mRNA vaccination against COVID-19 is safe in patients with MG and show no negative impact on the disease course. Patients achieved high humoral and cellular immune response levels.Classification of EvidenceThis study provides Class IV evidence that patients with MG receiving the mRNA-1273 vaccine did not show clinical worsening after vaccination and that most of the patients achieved high cellular or immune response levels.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Immune Response and Safety of SARS-CoV-2 mRNA-1273 Vaccine in Patients With Myasthenia Gravis

Reyes‐Leiva

López-Contreras

Moga

et al. 2022

Neurol Neuroimmunol Neuroinflamm

View full text Add to dashboard Cite

show abstract

“…Other studies have also found a diminished immune response in patients on fingolimod compared with patients treated with different disease-modifying therapies [25] . Finally, one study also showed an attenuated antibody response under immunosuppressive therapy (including fingolimod) [26] and a more recent paper shows that the vaccine response is attenuated in patients treated with fingolimod compared to other patients without background treatment [27] . We found that the development of antibodies was correlated to age: the proportion of people with a positive COVID serology decreases as age increases.…”

Section: Discussionmentioning

confidence: 99%

Serology results after COVID vaccine in multiple sclerosis patients treated with fingolimod

et al. 2023

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“…Thus, these data further show that antibody testing is generally not needed to confirm seroconversion and vaccine responsiveness after primary COVID-19 vaccination in healthy individuals. However, in individuals under immunosuppressive therapies antibody testing is useful to identify vaccine non-responders [ 15 , 16 ] and guide further prophylactic treatment options such as application of monoclonal antibodies.…”

Section: Discussionmentioning

confidence: 99%

Full seroconversion in initial non-responders with higher antibody levels after heterologous COVID-19 vaccination schedule.

et al. 2022

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Absent antibody production following COVID19 vaccination with mRNA in patients under immunosuppressive treatments

Cited by 7 publications

References 12 publications

Immune Response and Safety of SARS-CoV-2 mRNA-1273 Vaccine in Patients With Myasthenia Gravis

Immune Response and Safety of SARS-CoV-2 mRNA-1273 Vaccine in Patients With Myasthenia Gravis

Serology results after COVID vaccine in multiple sclerosis patients treated with fingolimod

Full seroconversion in initial non-responders with higher antibody levels after heterologous COVID-19 vaccination schedule.

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