COVID-19 vaccine immunogenicity in 16 patients with autoimmune systemic diseases. Lack of both humoral and cellular response to booster dose and ongoing disease modifying therapies

Cellular and humoral responses after second and third SARS-CoV-2 vaccinations in patients with autoimmune diseases treated with rituximab: specific T cell immunity remains longer and plays a protective role against SARS-CoV-2 reinfections

“…Contrarily to the general (healthy) population, cellular responses to SARS-CoV-2 have been found to be reduced in vulnerable populations, such as patients with primary immunodeficiencies or those secondarily immunocompromised ( 8 – 25 ), including those with autoimmune diseases ( 9 , 26 – 32 ). Most immunosuppressive agents, including glucocorticoids, mycophenolate, methotrexate, tumor necrosis factor (TNF) inhibitors, tocilizumab, abatacept, and rituximab have been associated with poor humoral responses in patients with autoimmune diseases after SARS-CoV-2 vaccination ( 26 – 28 , 32 ), and the highest risk has been identified with the use of rituximab ( 26 ). A retrospective series of 496 immunocompromised patients with debilitating diseases, including 149 with autoimmune diseases, found attenuated humoral and cellular responses after the initial SARS-CoV-2 vaccine since 62% of the cases seroconverted for anti-spike 1 IgG and 71% developed cellular responses.…”

“…However, a proportion of patients with immune-debilitating diseases have been described to lack complete humoral and/or cellular responses to SARS-CoV-2 vaccination, mainly to messenger RNA (mRNA) vaccines. These conditions include primary immunodeficiencies ( 8 – 10 ), neoplastic diseases ( 9 , 11 – 13 ), HIV infection and low CD4 lymphocyte counts ( 14 ), and liver cirrhosis ( 15 ), as well as patients on hemodialysis ( 16 , 17 ), recipients of solid organ transplants ( 9 , 16 , 18 – 20 ), stem cell transplantation ( 21 – 24 ), or CAR T-cell therapy ( 22 , 24 , 25 ), and patients with autoimmune diseases, such as rheumatoid arthritis (RA), spondyloarthropathies, systemic lupus erythematosus (SLE), mixed connective tissue disease, multiple sclerosis, autoimmune hepatitis, and different types of vasculitis, which are in turn treated with a wide variety of immunosuppressive agents ( 9 , 26 – 32 ).…”

Humoral Immunogenicity of mRNA Booster Vaccination after Heterologous CoronaVac-ChAdOx1 nCoV-19 or Homologous ChAdOx1 nCoV-19 Vaccination in Patients with Autoimmune Rheumatic Diseases: A Preliminary Report

“…In contrast, some studies reported suboptimal protective immunity after mRNA booster vaccination in patients with ARDs. For example, Gragnani et al demonstrated a significantly lower anti-RBD IgG level in patients with ARDs, compared to that in healthy individuals, and up to one-third of patients with ARDs who received mycophenolate mofetil or rituximab had a suboptimal humoral response after three homologous doses of the BNT162b2 vaccine [ 11 ]. Ferri C et al reported a similar finding, with 7.8% of patients with ARDs having suboptimal responses (≤70 BAU/mL) [ 12 ].…”

“…Previous studies on COVID-19 vaccine boosters in patients with ARDs have focused on mRNA primary series, and the seropositivity rate varied between 70–93% [ 11 , 12 , 13 ]; however, only half of these patients gained the optimal neutralizing capacity to the Omicron variants [ 14 , 15 ]. Despite these previous studies, immunogenicity data on primary series other than mRNA vaccines in patients with ARDs are limited.…”

Impact of COVID-19 and vaccination campaign on 1,755 systemic sclerosis patients during first three years of pandemic. Possible risks for individuals with impaired immunoreactivity to vaccine, ongoing immunomodulating treatments, and disease-related lung involvement during the next pandemic phase

“…The immunogenicity of COVID-19 vaccines was evaluated by measuring the titer of neutralizing antibodies (NAb) against SARS-CoV-2 trimeric spike S1/S2 glycoproteins on serum samples obtained within 2–4 weeks and 6 months after completion of the first vaccination cycle, and after the booster vaccine dose [ [19] , [20] , [21] ]. The NAb levels were measured by means of SARS- CoV-2 IgG II Quant antibody test kit (Abbott Laboratories, Chicago, IL).…”