Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: a multicentre study

• Published in: Annals of the rheumatic diseases Vol. 80; no. 10; pp. 1330 - 1338
• Main Authors: Furer, Victoria, Eviatar, Tali, Zisman, Devy, Peleg, Hagit, Paran, Daphna, Levartovsky, David, Zisapel, Michael, Elalouf, Ofir, Kaufman, Ilana, Meidan, Roni, Broyde, Adi, Polachek, Ari, Wollman, Jonathan, Litinsky, Ira, Meridor, Katya, Nochomovitz, Hila, Silberman, Adi, Rosenberg, Dana, Feld, Joy, Haddad, Amir, Gazzit, Tal, Elias, Muna, Higazi, Nizar, Kharouf, Fadi, Shefer, Gabi, Sharon, Orly, Pel, Sara, Nevo, Sharon, Elkayam, Ori
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.10.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adverse events; Antibodies; biological therapy; Classification; Coronaviruses; COVID-19; COVID-19 vaccines; Disease; Drug dosages; Epidemiology; Glucocorticoids; Herpes zoster; Immunogenicity; Immunoglobulin G; Immunotherapy; Infections; Influenza; Lupus; methotrexate; Monoclonal antibodies; mRNA; mRNA vaccines; Mycophenolate mofetil; Mycophenolic acid; Pandemics; Patients; Pericarditis; Population; Population studies; Rheumatic diseases; Rheumatoid arthritis; Rheumatology; Risk factors; Rituximab; Safety; Severe acute respiratory syndrome coronavirus 2; Uveitis; vaccination; Vaccines; Tel Aviv Israel; Israel
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2021-220647

IntroductionVaccination represents a cornerstone in mastering the COVID-19 pandemic. Data on immunogenicity and safety of messenger RNA (mRNA) vaccines in patients with autoimmune inflammatory rheumatic diseases (AIIRD) are limited.MethodsA multicentre observational study evaluated the immunogenicity and safety of the two-dose regimen BNT162b2 mRNA vaccine in adult patients with AIIRD (n=686) compared with the general population (n=121). Serum IgG antibody levels against SARS-CoV-2 spike S1/S2 proteins were measured 2–6 weeks after the second vaccine dose. Seropositivity was defined as IgG ≥15 binding antibody units (BAU)/mL. Vaccination efficacy, safety, and disease activity were assessed within 6 weeks after the second vaccine dose.ResultsFollowing vaccination, the seropositivity rate and S1/S2 IgG levels were significantly lower among patients with AIIRD versus controls (86% (n=590) vs 100%, p<0.0001 and 132.9±91.7 vs 218.6±82.06 BAU/mL, p<0.0001, respectively). Risk factors for reduced immunogenicity included older age and treatment with glucocorticoids, rituximab, mycophenolate mofetil (MMF), and abatacept. Rituximab was the main cause of a seronegative response (39% seropositivity). There were no postvaccination symptomatic cases of COVID-19 among patients with AIIRD and one mild case in the control group. Major adverse events in patients with AIIRD included death (n=2) several weeks after the second vaccine dose, non-disseminated herpes zoster (n=6), uveitis (n=2), and pericarditis (n=1). Postvaccination disease activity remained stable in the majority of patients.ConclusionmRNA BNTb262 vaccine was immunogenic in the majority of patients with AIIRD, with an acceptable safety profile. Treatment with glucocorticoids, rituximab, MMF, and abatacept was associated with a significantly reduced BNT162b2-induced immunogenicity.