A Single-Center Covid Vaccination Experience in Patients with Sjogren's Syndrome

ABSTRACT

Introduction. Vaccination against SARS-CoV2 is beneficial for patients with autoimmune disease. Therefore, we recommended basic immunization as soon as it has become available for our patients. We preferred mRNAbased vaccination based on the international recommendations. However, several patients received other types of vaccines at their own or their general practitioner's discretion. Based on the antibody levels against the SARSCoV2 spike protein measured at the Institute of Laboratory Medicine of our university, we were able to draw initial conclusions about the effectiveness of vaccination regarding our primary Sjogren's syndrome patients. Patients and methods. Antibodies to SARS-CoV2 spike protein were analyzed in the sera of 77 patients with primary Sjogren's syndrome after being vaccinated with two doses between 1st January and 30th April, 2021, at least 30 days after the second vaccination. Antibody responses were classified as high (above 250 U/ml), moderate (between 50 and 250 U/ml) and low (below 50 U/ml). Relying on the SPSS statistical program, we were seeking correlations between the serum levels and the EULAR Sjogren's syndrome disease activity index (ESSDAI) and the potential influence of the different immunosuppressive treatment modalities, respectively. For the statistical analysis, chi2 tests were performed. Result(s) Pfizer vaccine was given to 58 patients, and the rest of our cohort received Moderna (2 patients), Sinopharm (10 patients), Astra Zeneca (6 patients) and Sputnik vaccine (1 patient). High antibody levels were found in 54 subjects (70.1%), moderate levels in 11 subjects (14.3%), and low levels in 12 subjects (15.6%). After having received the Pfizer vaccine, 86.2% had high, and only 5.2% had low antibody levels. One patient vaccinated with Moderna had high, while the other had low antibody level. The majority (55%) of those vaccinated with Astra Zeneca achieved high titers, and 17% were classified as low responders. After immunization with Sinopharm vaccine, 20% of the patients were classified into moderate response category, while the rest (80%) presented low antibody levels. We also measured low value in the serum of the patient that received the Sputnik vaccine. Serum levels of specific antibodies in patients not receiving any specific therapy (14 subjects) did not differ significantly from those treated with antimalarials (18 subjects), methotrexate (19 subjects), azathioprine (6 subjects), or low-dose steroids (20 subjects). Based on our results, the type of immunosuppressive treatment had less effect on the protection developed than the type of vaccination. There was no significant correlation between Sjogren's syndrome disease activity and the degree of specific antibody response to the vaccine. Conclusions. Our initial results suggest that the use of COVID vaccines is safe and effective for Sjogren's syndrome patients, regardless of the treatment used or of the ESSDAI.