Your browser doesn't support javascript.
Effect of Immunosuppression on the Immunogenicity of mRNA Vaccines to SARS-CoV-2 : A Prospective Cohort Study.
Deepak, Parakkal; Kim, Wooseob; Paley, Michael A; Yang, Monica; Carvidi, Alexander B; Demissie, Emanuel G; El-Qunni, Alia A; Haile, Alem; Huang, Katherine; Kinnett, Baylee; Liebeskind, Mariel J; Liu, Zhuoming; McMorrow, Lily E; Paez, Diana; Pawar, Niti; Perantie, Dana C; Schriefer, Rebecca E; Sides, Shannon E; Thapa, Mahima; Gergely, Maté; Abushamma, Suha; Akuse, Sewuese; Klebert, Michael; Mitchell, Lynne; Nix, Darren; Graf, Jonathan; Taylor, Kimberly E; Chahin, Salim; Ciorba, Matthew A; Katz, Patricia; Matloubian, Mehrdad; O'Halloran, Jane A; Presti, Rachel M; Wu, Gregory F; Whelan, Sean P J; Buchser, William J; Gensler, Lianne S; Nakamura, Mary C; Ellebedy, Ali H; Kim, Alfred H J.
  • Deepak P; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Kim W; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Paley MA; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Yang M; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • Carvidi AB; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • Demissie EG; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • El-Qunni AA; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Haile A; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Huang K; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Kinnett B; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Liebeskind MJ; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Liu Z; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • McMorrow LE; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Paez D; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • Pawar N; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • Perantie DC; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Schriefer RE; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Sides SE; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Thapa M; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Gergely M; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Abushamma S; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Akuse S; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Klebert M; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Mitchell L; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Nix D; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Graf J; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • Taylor KE; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • Chahin S; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Ciorba MA; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Katz P; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • Matloubian M; University of California San Francisco, San Francisco, California (M.Y., A.B.C., E.G.D., D.P., N.P., J.G., K.E.T., P.K., M.M.).
  • O'Halloran JA; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Presti RM; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Wu GF; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Whelan SPJ; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Buchser WJ; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Gensler LS; University of California San Francisco and San Francisco VA Health Care System, San Francisco, California (L.S.G., M.C.N.).
  • Nakamura MC; University of California San Francisco and San Francisco VA Health Care System, San Francisco, California (L.S.G., M.C.N.).
  • Ellebedy AH; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
  • Kim AHJ; Washington University School of Medicine, St. Louis, Missouri (P.D., W.K., M.A.P., A.A.E., A.H., K.H., B.K., M.J.L., Z.L., L.E.M., D.C.P., R.E.S., S.E.S., M.T., M.G., S.A., S.A., M.K., L.M., D.N., S.C., M.A.C., J.A.O., R.M.P., G.F.W., S.P.W., W.J.B., A.H.E., A.H.K.).
Ann Intern Med ; 174(11): 1572-1585, 2021 11.
Article in English | MEDLINE | ID: covidwho-1547666
ABSTRACT

BACKGROUND:

Patients with chronic inflammatory disease (CID) treated with immunosuppressive medications have increased risk for severe COVID-19. Although mRNA-based SARS-CoV-2 vaccination provides protection in immunocompetent persons, immunogenicity in immunosuppressed patients with CID is unclear.

OBJECTIVE:

To determine the immunogenicity of mRNA-based SARS-CoV-2 vaccines in patients with CID.

DESIGN:

Prospective observational cohort study.

SETTING:

Two U.S. CID referral centers.

PARTICIPANTS:

Volunteer sample of adults with confirmed CID eligible for early COVID-19 vaccination, including hospital employees of any age and patients older than 65 years. Immunocompetent participants were recruited separately from hospital employees. All participants received 2 doses of mRNA vaccine against SARS-CoV-2 between 10 December 2020 and 20 March 2021. Participants were assessed within 2 weeks before vaccination and 20 days after final vaccination. MEASUREMENTS Anti-SARS-CoV-2 spike (S) IgG+ binding in all participants, and neutralizing antibody titers and circulating S-specific plasmablasts in a subset to assess humoral response after vaccination.

RESULTS:

Most of the 133 participants with CID (88.7%) and all 53 immunocompetent participants developed antibodies in response to mRNA-based SARS-CoV-2 vaccination, although some with CID developed numerically lower titers of anti-S IgG. Anti-S IgG antibody titers after vaccination were lower in participants with CID receiving glucocorticoids (n = 17) than in those not receiving them; the geometric mean of anti-S IgG antibodies was 357 (95% CI, 96 to 1324) for participants receiving prednisone versus 2190 (CI, 1598 to 3002) for those not receiving it. Anti-S IgG antibody titers were also lower in those receiving B-cell depletion therapy (BCDT) (n = 10). Measures of immunogenicity differed numerically between those who were and those who were not receiving antimetabolites (n = 48), tumor necrosis factor inhibitors (n = 39), and Janus kinase inhibitors (n = 11); however, 95% CIs were wide and overlapped. Neutralization titers seemed generally consistent with anti-S IgG results. Results were not adjusted for differences in baseline clinical factors, including other immunosuppressant therapies.

LIMITATIONS:

Small sample that lacked demographic diversity, and residual confounding.

CONCLUSION:

Compared with nonusers, patients with CID treated with glucocorticoids and BCDT seem to have lower SARS-CoV-2 vaccine-induced antibody responses. These preliminary findings require confirmation in a larger study. PRIMARY FUNDING SOURCE The Leona M. and Harry B. Helmsley Charitable Trust, Marcus Program in Precision Medicine Innovation, National Center for Advancing Translational Sciences, and National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Fulltext
Print
XML
PubMed Links
Search on Google

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Vaccines Language: English Journal: Ann Intern Med Year: 2021 Document Type: Article

Similar

MEDLINE
LILACS
LIS
Fulltext
Print
XML
PubMed Links
Search on Google

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Vaccines Language: English Journal: Ann Intern Med Year: 2021 Document Type: Article