Objectives
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and joint destruction. Biologics are crucial to achieving treat-to-target goals in patients with RA. The global spread and continuous variation of SARS-CoV-2 necessitate monitoring variant-specific humoral responses post-vaccination. This study aims to investigate how different biologic treatments for vaccinated RA patients may affect their neutralizing antibodies against multiple SARS-CoV-2 variants.
Methods
We recruited RA patients who had received three doses of conventional SARS-CoV-2 vaccines and were treated with various biologics, e.g., TNF inhibitor (etanercept), IL-6 inhibitor (tocilizumab), CTLA4-Ig (abatacept) or anti-CD20 (rituximab). Serum samples were used to profile the binding and neutralizing antibodies using our own SARS-CoV-2 variant (CoVariant) protein array, developed previously.
Results
Compared to healthy controls, only RA therapy with rituximab showed a reduction in neutralizing antibodies capable of targeting spike proteins in SARS-CoV-2 wild-type and most variants. This reduction is not observed in binding antibodies against SARS-CoV-2 wild-type or its variants.
Conclusions
After receiving three doses of SARS-CoV-2 vaccination, RA patients who underwent Rituximab treatment generated sufficient antibodies but exhibited lower neutralizing activities against wild-type and multiple variants, including current Omicron. Other biological DMARDs, e.g., TNF inhibitor, IL-6 inhibitor, and CTLA4-Ig, did not show obvious inhibition.
Lay summary
What does this mean for patients ?
This research examined the impact of various biologic treatments (a type of drug) on the immune response of rheumatoid arthritis (RA) patients to COVID-19 vaccination. The study revealed that RA patients treated with rituximab had significantly lower levels of neutralizing antibodies against various SARS-CoV-2 variants, including Omicron, even after receiving three vaccine doses. Neutralizing antibodies defend the body from organisms that cause disease, such as viruses, by preventing them from entering our cells. In contrast, RA patients receiving other biologic therapies, including TNF inhibitors, IL-6 inhibitors, or CTLA4-Ig, did not experience the same reduction in neutralizing antibodies. No significant difference was found in serum antibodies, regardless of the specific biologic therapy (TNF inhibitors, IL-6 inhibitors, CTLA4-Ig, or anti-CD20). This study highlights the different immune responses to COVID-19 vaccination in patients with RA treated with various biologics. Therefore, individuals with RA who are considering or are currently undergoing biologic treatment should engage in thorough discussions with their healthcare providers regarding vaccination strategies. In summary, this study underscores the necessity for personalized vaccination strategies for RA patients based on their specific treatment regimens to ensure robust protection against evolving COVID-19 variants.