Interaction of TNFi and conventional synthetic DMARD in SARS-CoV-2 vaccine response in axial spondyloarthritis and psoriatic arthritis

• Published in: Joint, bone, spine : revue du rhumatisme Vol. 90; no. 1; p. 105464
• Main Authors: G.S. Saad, Carla, S.R. Silva, Matheus, Sampaio-Barros, Perceval D., C.B. Moraes, Julio, G. Schainberg, Cláudia, Gonçalves, Celio R., Shimabuco, Andrea Y., Aikawa, Nadia E., F.N. Yuki, Emily, G. Pasoto, Sandra, V.K. Kupa, Leonard, K. Aoyama, Renato, S.R. Araujo, Carlo, Silva, Clóvis A., Medeiros-Ribeiro, Ana C., Bonfa, Eloisa
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.01.2023; Société française de rhumatologie. Published by Elsevier Masson SAS
• Subjects: Ankylosing spondylitis; Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - drug therapy; Axial Spondyloarthritis; COVID-19; COVID-19 Vaccines - therapeutic use; Female; Humans; Male; Methotrexate - therapeutic use; Prednisone - therapeutic use; Prospective Studies; Psoriatic arthritis; SARS-CoV-2; Spondylarthritis - drug therapy; Sulfasalazine - therapeutic use; Therapeutics and TNFi; Treatment Outcome; Tumor Necrosis Factor Inhibitors - therapeutic use; Tumor Necrosis Factor-alpha - therapeutic use; Vaccination; COVID-19; Therapeutics and TNFi; Vaccination; Ankylosing spondylitis; Psoriatic arthritis
• ISSN: 1297-319X; 1778-7254
• DOI: 10.1016/j.jbspin.2022.105464

•TNF inhibitors attenuate humoral response to SARS-CoV-2 vaccine in SpA patients.•Sulfasalazine has a positive impact on vaccine antibody production.•Vaccine humoral response was comparable between SpA patients without current DMARD/prednisone and control group.•Pre-vaccination disease activity status did not influence humoral response. To evaluate humoral responses to three doses of the inactivated SARS-CoV-2 vaccine (CoronaVac) in patients with spondyloarthritis (SpA) and the effect of therapy, compared with a control group (CG). Prospective cohort of axial SpA/psoriatic arthritis patients and age/sex-balanced CG from the CoronavRheum phase 4 trial (NCT04754698). CoronaVac was given in two doses (28-days interval) with a booster at day 210. Blood samples were collected in the days 0/28 (D28)/69 (D69) and 240 (D240) to evaluate anti-SARS-CoV-2 IgG seropositivity (SP) and neutralising antibodies (NAb). One hundred and ninety-four SpA patients were enrolled and 183 patients were age/sex-balanced with 183 CG. At D69, SpA patients showed a high SP (80.2% vs. 95.7%, P<0.001) and moderate NAb positivity (61.6% vs. 82.7%, P<0.001), but lower than CG. In patients, older age prednisone (P<0.001), methotrexate (MTX) (P<0.001) and TNF inhibitors (TNFi) (P<0.001) were independently associated with lower SP, while Caucasian ethnicity (P<0.05) and prednisone (P<0.01) were associated with diminished NAb. In contrast, sulfasalazine (SSZ) use was associated with NAb presence (P<0.05). In monotherapy, only TNFi was also associated with absence of SP (P<0.05). Further comparison with CG revealed that TNFi and/or MTX negatively impacted SP/NAb (P<0.05). In contrast, patients under SSZ monotherapy achieved 100% SP (P>0.999) and 83.3% NAb positivity (P>0.999). SSZ+TNFi combination resulted in a similar response than CG [SP (P=0.153) and NAb (P=0.715)]. After third dose (D69–D240), a major increment occurred for SP (81.3% to 93.1%, P<0.001) and NAb (63.2% to 86.1%, P<0.001), but still lower than CG (P<0.05), and only TNFi impaired both SP (P=0.016)/NAb (P=0.002). We provided novel data demonstrating that TNFi attenuates immunogenicity in SpA patients while SSZ has a positive impact on vaccine antibody production. We also confirmed that MTX in combination with TNFi had a major negative impact in vaccine humoral response (CoronavRheum clinicaltrials.gov #NCT04754698).