Comparison of Immunogenicity and Safety of Inactivated, Adenovirus-Vectored, and Heterologous Adenovirus-Vectored/mRNA Vaccines in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Prospective Cohort Study

• Published in: Vaccines (Basel) Vol. 10; no. 6; p. 853
• Main Authors: Assawasaksakul, Theerada, Lertussavavivat, Tanat, Sathitratanacheewin, Seelwan, Oudomying, Nont, Vichaiwattana, Preeyaporn, Wanlapakorn, Nasamon, Poovorawan, Yong, Avihingsanon, Yingyos, Assawasaksakul, Nawaporn, Buranapraditkun, Supranee, Kittanamongkolchai, Wonngarm
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 26.05.2022; MDPI
• Subjects: Adenovirus; Adenoviruses; Antibodies; Arthritis; Autoimmune diseases; Binding; Chronic conditions; Cohort analysis; Coronaviruses; COVID-19; COVID-19 vaccines; Deactivation; Drug dosages; Enzyme-linked immunosorbent assay; Immune response; Immune response (cell-mediated); Immune response (humoral); Immune system; Immunogenicity; Immunoglobulins; Immunosuppressive agents; Lupus; mRNA; mRNA vaccines; Pandemics; reactogenicity; Rheumatic diseases; Rheumatoid arthritis; Safety; SARS-CoV-2 vaccine; Severe acute respiratory syndrome coronavirus 2; SLE; Software; Spike protein; Systemic lupus erythematosus; Vaccines; Variance analysis; Beijing China; Thailand; United States > US; China; SARS-CoV-2 vaccine; SLE; safety; immunogenicity; reactogenicity; RA
• ISSN: 2076-393X; 2076-393X
• DOI: 10.3390/vaccines10060853

Background: Impaired immune responses to COVID-19 vaccines have been observed in autoimmune rheumatic disease patients. Determining the most effective and safe vaccine regimen is critically needed in such a population. We aim to compare the immunogenicity and safety of three COVID-19 vaccine regimens in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Methods: SLE and RA patients aged 18−65 years who received inactivated (CoronaVac or COVILO), adenovirus-vectored (AZD1222), or heterogeneous (AZD1222/BNT162b2) vaccines were enrolled. Humoral and cellular immune responses were assessed at day 28 after the second vaccination. This was performed using the serum binding antibody level against the receptor-binding domain of the SARS-CoV-2 spike protein (anti-RBD Ig) and IFNy-ELISpot assay (ELISpot), respectively. Reactogenicity was reviewed on day 7 following each vaccination. Disease activity was assessed before and on day 28 after the second vaccination. Results: The cohort consisted of 94 patients (64 SLE and 30 RA). Inactivated, AZD1222, and AZD1222/BNT162b2 vaccines were administered to 23, 43, and 28 patients, respectively. Anti-RBD titers were lowest in the inactivated vaccine group (2.84 AU/mL; 95% CI 0.96−8.44), followed by AZD1222 (233.7 AU/mL; 95% CI 99.0−505.5), and AZD1222/BNT162b2 (688.6 AU/mL; 95% CI 271−1745), p < 0.0001. After adjusting for relevant factors, the inactivated vaccine was associated with the lowest humoral response, while adenovirus-vectored/mRNA vaccine was the highest. The proportion of positive ELISpot test was also lowest in the inactivated vaccine group (27%), followed by the adenovirus-vectored vaccine (67%), and the adenovirus-vectored/mRNA vaccine (73%) (p = 0.03). All types of vaccine were well-tolerated. There was no flare of autoimmune disease post-vaccination. Conclusion: Adenovirus-vectored and adenovirus-vectored/mRNA vaccines elicited a stronger humoral and cellular immune response than inactivated vaccines, suggesting that they may be more suitable in SLE and RA patients receiving immunosuppressive therapy.