Lower COVID-19 Immune Response Rate in Patients With Rheumatic Disease

While most patients with rheumatic disease achieved an immune response after the second dose of the COVID-19 vaccine, response rate was much lower when compared with controls, according to an upcoming ACR presentation, “Efficacy of SARS-CoV-2 Vaccine in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis.”

The Study

Investigators searched Pubmed/Medline, Scopus, and MedRxiv to find studies that determined immunogenicity of the COVID-19 vaccination in patients with rheumatic disease dated between January 1 and August 31, 2021, specifically including studies that reported humoral immune response in this patient population. Exclusion criteria included duplicate records, incomplete information, overlap, review articles, case series, and those that assessed immune response after the first dose of the vaccine. Rheumatic disease diagnosis and immunosuppressant medication data was collected. Immune response was described as developing COVID-19 IgG antibodies to the anti-receptor binding domain (RBD) or neutralizing antibodies >1 week after the second dose.

The Findings

Of the 1393 studies identified, a total of 18 case-control and observational studies examined 2826 patients with rheumatic disease and 2246 controls. In the rheumatic disease cohort, most patients had inflammatory arthritis (53.8%), 50.4% were receiving anti-metabolites, 66.8% received the mRNA vaccine type, and 33% received vaccination via viral vector or inactivated virion. Other rheumatic diseases included were connective tissue disorders (29.6%) and systemic lupus erythematosus (13.4%). Other immunosuppressant therapies included biologic and targeted therapies (n = 1279, 45.3%), glucocorticoids (n = 800, 28.3%), and B-cell depleting therapies (n = 416, 14.7%),.

The humoral immune response rate of vaccinated patients in both cohorts was 79.55%. However, when compared with controls, patients with rheumatic disease had significantly lower odds of seroconversion (OR 0.11 [95% CI 0.05-0.24]).

Patients on B-cell depleting therapies, such as rituximab and mycophenolate had the lowest seroconversion rates (<40% and <60%, respectively). Roughly 75% of patients receiving methotrexate had an immune response following the second dose.

Among those receiving biologic treatment, abatacept had the lowest seroconversion rate (<70%). Conversely, those on tumor necrosis factor (TNF) and intereleukin-17 (IL-17) inhibitors had the highest vaccine response rates (>90%).

“[Results are] likely driven by certain immunosuppressants particularly B-cell depleting therapy which can hamper the humoral immune response,” investigators concluded. “Future studies need to identify strategies to improve seroconversion rates in such patients on immunosuppressants.”