The SARS-CoV-2 vaccine response in ANCA-associated vasculitis

ABSTRACT

Background: The development of efficacious vaccines against COVID-19 is an overarching achievement of modern medicine. This efficacy, however, may not be achieved in patients on immunosuppression. We looked to ascertain humoral response and tolerability of these vaccines in patients with ANCA associated vasculitis(AAV) treated with B-cell depleting agents Methods: AAV patients who completed 2 doses of BNT162b2 or mRNA-1273 or a dose of JNJ-78436735, subsequently screened for spike protein antibody against SARSCoV-2 were included in the study. Clinical details, demographics and immunosuppression regimes were ascertained, with primary outcome being humoral response to SARSCoV-2.Statistics included Fischer's exact test and Wilcoxon rank sum test. Results: Forty-eight patients with a mean age of 67y(35% female) completed vaccine series with BNT161b2(n=19), mRNA-1273(n=25) and JNJ-78436735(n=4). Vaccine associated side effects occurred in 27% of patients after 1st dose, with 39% after the 2nd dose. Spike protein antibody was tested at a median of 31 days after vaccination-30(61%) patients had demonstrable antibody. All patients (n=44) other than 4 post-transplant patients, were treated with Rituximab-only 17/44(39%) developed an antibody response. In the setting of rituximab treatment, absence of seroconversion post vaccination was associated with vaccine type, duration elapsed since last rituximab dose (figure 1), low IgM level and absence of B-cell reconstitution (all stastically significant). Two patients without serologic response had severe COVID-19 infection Conclusions: This data demonstrates that majority of patients treated with rituximab lack demonstrable serologic response, with risk of severe COVID-19 infections despite vaccination. Confirmation of B-cell reconstitution before vaccination may have a bearing on serological conversion. It is imperative that authorities consider these factors while designing vaccination schedules and provide recommendations for booster doses in this vulnerable population.