Improvement of humoral immunity by repeated dose-intensified COVID-19 vaccinations in primary non- to low-responders and B cell deficient rheumatic disease patients.
J Autoimmun
; 135: 102996, 2023 02.
Article
in English
| MEDLINE | ID: covidwho-2180079
ABSTRACT
OBJECTIVE:
To determine whether repeated, dose-intensified mRNA vaccinations against COVID-19 increase humoral immunity in previously low-responding patients with autoimmune rheumatic diseases (AIRD), including rituximab-treated and B cell depleted patients.METHODS:
Of 308 AIRD patients receiving basic immunization, 98 had a low serological response against SARS-CoV-2 with a neutralizing capacity of < 70% using surrogate neutralization assay. 38 patients received a third vaccination with 30 µg BNT162b2 16 weeks after second vaccination. If neutralizing serum capacity was below 70% four weeks after the last vaccination, then the fourth vaccination (n = 19) and the fifth (n = 4) vaccination with 100 µg mRNA-1273 took place eight weeks after the last vaccination.RESULTS:
Each of the three booster vaccinations resulted in a significant increase of mean serum neutralizing capacity (3rd Δ = 42%, p < 0.001; 4th Δ = 19%, p = 0.049 and 5th Δ = 51%, p = 0.043) and produced a significant proportion of high-responders (3rd 34%; 4th 32% and 5th 75%). Low B cell counts (p = 0.047), lower previous antibody response (p < 0.001) and rituximab therapy (p = 0.021) were negatively associated with successful response to the third but not to the fourth vaccination. Remarkably, substantial increases in neutralization capacity of up to 99% were observed after repeated vaccinations in B cell depleted patients.CONCLUSION:
AIRD patients with low humoral response benefited from up to three repeated dose-intensified mRNA booster vaccinations - despite low B cell count and previous rituximab therapy. Each additional vaccination substantially reduced the number of low-responding, vulnerable patients.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Autoimmune Diseases
/
Rheumatic Diseases
/
COVID-19
Topics:
Vaccines
Limits:
Humans
Language:
English
Journal:
J Autoimmun
Journal subject:
Allergy and Immunology
Year:
2023
Document Type:
Article
Affiliation country:
J.jaut.2023.102996
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