Humoral response to a third injection of BNT162b2 vaccine in patients on maintenance haemodialysis

Abstract

Background Humoral response against SARS-CoV-2 after two doses of BNT162b2 (Pfizer-BioNTech) has been proven less intense in maintenance dialysis patients as compared to healthy subjects, leading the French authorities to recommend a third injection in this population. Here, we investigated the response to the third injection in two cohorts of hemodialysis patients. Methods Data from two prospective observational cohorts were collected. In the first -“systematic”- cohort, patients from 2 hemodialysis centers (n = 66) received a 3rd injection of BNT162b2, regardless of the response after two injections. In the second -“conditional”- cohort, the injection was only prescribed to patients (n = 34) with no or low response to the previous two doses. In both cohorts, the 3rd dose was injected 1 to 2 months after the 2nd dose. Serology was performed after the 2nd and 3rd dose to assess anti-Spike IgG antibody titer. Results In the “systematic” cohort, anti-Spike IgG were found in 83.3% and 92.4% of patients after the 2nd and the 3rd dose of BNT162b2, respectively. In this cohort, 6/11 (54.5%) and 20/21 (95.2%) patients switched from non-responder to low-responder and from low-responder to high-responder, respectively. In low and high-responders to 2 doses, 50/55 (90.9%) at least doubled their anti-Spike IgG titer. Similar trends were observed in the “conditional” cohort. Conclusions In maintenance hemodialysis patients, humoral response against SARS-Cov-2 was boosted after a third dose of BNT162b2, allowing seroconversion in more than half of non-responders. These data may support an intensified vaccination protocol with a 3rd dose of BNT162b2 in dialysis patients.

Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients

“…This suggestion is also supported by a recent report on hemodialysis patients, in which homologous ChAd/ChAd vaccination induced lower SARS-CoV-2-spike-IgG-levels in COVID-19-naïve hemodialysis patients than homologous BNT/BNT vaccination [ 30 ]. Also, in a recent study of hemodialysis patients, a third dose of BNT162b2 allowed seroconversion in more than half of non-responders [ 31 ] or enhanced humoral response in almost all hemodialysis patients. Dialysis patients with low humoral response may benefit from a third dose of BNT162b2 mRNA COVID-19 vaccine [ 24 ].…”

Antibody Response to mRNA Vaccines against SARS-CoV-2 with Chronic Kidney Disease, Hemodialysis, and after Kidney Transplantation

“…In particular, the very low titers in KTR are alarming, not only regarding the potential of vaccines to protect against COVID-19 disease, but also the longevity of the supposed protection. Several trials have already reported on immune responses to a third vaccine dose in KTR non-responders [ 28 , 29 , 30 ] and weak responders [ 31 ], as well as HD patients [ 32 , 33 ]. Approximately 50% of KTR developed a positive AB response after a third dose.…”

An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment

“…This contributes to an increasing number of breakthrough infections ( Shroff et al, 2021 ; Juno and Wheatley, 2021 ; Goldberg et al, 2021 ; Fowlkes et al, 2021 ; Davidovic et al, 2021 ; Campo et al, 2021 ). Currently, several countries have developed various strategies to tackle this problem, among which, additional doses of COVID-19 vaccines have shown to be safe and efficient in boosting immune response ( Yue et al, 2021 ; Falsey et al, 2021 ; Dekervel et al, 2021 ; Choi et al, 2021 ; Barros-Martins et al, 2021 ). Nonetheless, the low vaccination rate, coupled with the risk of emergence of vaccine-resistant SARS-CoV-2 variants and waning immunity, emphasizes the burning need to develop novel drugs and therapeutic modalities for COVID-19 ( Artese et al, 2020 ; Twomey et al, 2020 ; Drożdżal et al, 2020 ).…”