Effect of Mycophenolate Mofetil Dosing on Antibody Response to SARS-CoV-2 Vaccination in Heart and Lung Transplant Recipients
American Journal of Transplantation
; 22(Supplement 3):440, 2022.
Article
in English
| EMBASE | ID: covidwho-2063372
ABSTRACT
Purpose:
Mycophenolate mofetil (MMF) use is associated with decreased antibody response to the SARS-CoV-2 mRNA vaccine series in heart and lung transplant recipients (HLTRs). Higher MMF doses have been associated with poor immunogenicity in kidney transplant recipients, but limited data exist on HLTRs. We evaluated the relationship between daily MMF dose and vaccine-induced antibody response in HLTRs. Method(s) HLTRs (n= 212) from an observational cohort were categorized by daily MMF doses (None, Low <1000mg, Moderate 1000-2000mg, High >=2000mg). Semi-quantitative antibody testing was performed at 1, 3, and 6-months post-dose 2 (D2) using the Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay (EIA), testing for antibodies to SARSCoV2 spike protein receptor binding domain, and the EUROIMMUN EIA, testing for S1 domain of SARS-CoV-2 spike protein. Multivariable Poisson regression was used to estimate the risk of a negative antibody response with increasing MMF dose. Result(s) At the time of vaccination, 94 (44.3%) HLTRs reported receiving no MMF, 33 (15.6%) reported a low dose, 54 (25.7%) reported a moderate dose, and 31 (14.8%) reported a high dose regimen. There were statistically significant differences in the number of participants on mTOR inhibitors and Triple immunosuppression among the groups but the participants in all 4 dose categories were otherwise comparable (Table 1) The risk ratio of a negative post-D2 titer with low, moderate and high dose regimens compared to no MMF was 0.65 1.15 2.05 (p=0.63), 1.34 2.043.10 (p=0.001) and 1.83 2.77 4.21 (p<0.001) after adjusting for age, sex, vaccine type, time since transplant, and corticosteroid use. Conclusion(s) HLTRs taking MMF >1000mg/day are at higher risk of remaining seronegative after mRNA vaccination, with evidence of a dose-nonresponse effect. The findings support the exploration of whether targeted MMF reduction strategies in HLTRs increase SARS-CoV-2 vaccine immunogenicity. (Table Presented).
adult; antibody response; cohort analysis; conference abstract; controlled study; drug combination; drug dose regimen; drug therapy; enzyme immunoassay; female; gene expression; graft recipient; heart; human; immunoassay analyzer; immunosuppressive treatment; low drug dose; lung; major clinical study; male; nonhuman; Poisson regression; protein domain; quantitative analysis; receptor binding; risk assessment; Severe acute respiratory syndrome coronavirus 2; vaccination; vaccine immunogenicity; corticosteroid; endogenous compound; mammalian target of rapamycin inhibitor; messenger RNA; mycophenolate mofetil; SARS-CoV-2 vaccine; transcription factor Sox18; virus spike protein
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Experimental Studies
Topics:
Vaccines
Language:
English
Journal:
American Journal of Transplantation
Year:
2022
Document Type:
Article
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