Safety and efficacy of the mRNA BNT162b2 vaccine against SARS-CoV-2 in five groups of immunocompromised patients and healthy controls in a prospective open-label clinical trial

• Published in: EBioMedicine Vol. 74; p. 103705
• Main Authors: Bergman, Peter, Blennow, Ola, Hansson, Lotta, Mielke, Stephan, Nowak, Piotr, Chen, Puran, Söderdahl, Gunnar, Österborg, Anders, Smith, C. I. Edvard, Wullimann, David, Vesterbacka, Jan, Lindgren, Gustaf, Blixt, Lisa, Friman, Gustav, Wahren-Borgström, Emilie, Nordlander, Anna, Gomez, Angelica Cuapio, Akber, Mira, Valentini, Davide, Norlin, Anna-Carin, Thalme, Anders, Bogdanovic, Gordana, Muschiol, Sandra, Nilsson, Peter, Hober, Sophia, Loré, Karin, Chen, Margaret Sällberg, Buggert, Marcus, Ljunggren, Hans-Gustaf, Ljungman, Per, Aleman, Soo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2021; Elsevier
• Subjects: Adenine - adverse effects; Adenine - analogs & derivatives; Adenine - therapeutic use; Advanced Basic Science; Antibodies, Viral - blood; BNT162 Vaccine - adverse effects; BNT162 Vaccine - immunology; CAR-T; chronic lymphocytic leukemia; COVID-19 - prevention & control; Female; Hematopoietic Stem Cell Transplantation; HIV; human stem-cell transplantation; Humans; Immunocompromised Host - immunology; Immunocompromised patients; Immunogenicity, Vaccine - immunology; Immunotherapy, Adoptive; Internal Medicine; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; mRNA BNT162b2 vaccine; Mycophenolic Acid - adverse effects; Mycophenolic Acid - therapeutic use; Organ Transplantation; Piperidines - adverse effects; Piperidines - therapeutic use; Primary Immunodeficiency; Primary Immunodeficiency Diseases - immunology; Prospective Studies; Research paper; SARS-CoV-2 - immunology; Seroconversion; solid organ transplantation; Spike Glycoprotein, Coronavirus - immunology; Vaccination - adverse effects; Vaccine Efficacy; human stem-cell transplantation; PP; CLL; CAR T; ITT; PID; Primary Immunodeficiency; mPP; Immunocompromised patients; mRNA BNT162b2 vaccine; COVID-19; SARS-CoV-2; chronic lymphocytic leukemia; HIV; CAR-T; solid organ transplantation; SOT; HSCT; Per protocol; Primary immunodeficiency disorders; Allogeneic hematopoietic stem cell transplantation; Intention to treat; Coronavirus disease 2019; Chimeric antigen receptor T; Severe acute respiratory syndrome coronavirus 2; Modified per protocol; Human immunodeficiency virus
• ISSN: 2352-3964; 2352-3964
• DOI: 10.1016/j.ebiom.2021.103705

Patients with immunocompromised disorders have mainly been excluded from clinical trials of vaccination against COVID-19. Thus, the aim of this prospective clinical trial was to investigate safety and efficacy of BNT162b2 mRNA vaccination in five selected groups of immunocompromised patients and healthy controls. 539 study subjects (449 patients and 90 controls) were included. The patients had either primary (n=90), or secondary immunodeficiency disorders due to human immunodeficiency virus infection (n=90), allogeneic hematopoietic stem cell transplantation/CAR T cell therapy (n=90), solid organ transplantation (SOT) (n=89), or chronic lymphocytic leukemia (CLL) (n=90). The primary endpoint was seroconversion rate two weeks after the second dose. The secondary endpoints were safety and documented SARS-CoV-2 infection. Adverse events were generally mild, but one case of fatal suspected unexpected serious adverse reaction occurred. 72.2% of the immunocompromised patients seroconverted compared to 100% of the controls (p=0.004). Lowest seroconversion rates were found in the SOT (43.4%) and CLL (63.3%) patient groups with observed negative impact of treatment with mycophenolate mofetil and ibrutinib, respectively. The results showed that the mRNA BNT162b2 vaccine was safe in immunocompromised patients. Rate of seroconversion was substantially lower than in healthy controls, with a wide range of rates and antibody titres among predefined patient groups and subgroups. This clinical trial highlights the need for additional vaccine doses in certain immunocompromised patient groups to improve immunity. Knut and Alice Wallenberg Foundation, the Swedish Research Council, Nordstjernan AB, Region Stockholm, Karolinska Institutet, and organizations for PID/CLL-patients in Sweden.