Individuals with chronic inflammatory diseases (CID) are frequently treated with immunosuppressive medications that can increase their risk of severe COVID-19. While novel mRNA-based SARS-CoV-2 vaccination platforms provide robust protection in immunocompetent individuals, the immunogenicity in CID patients on immunosuppression is not well established. Therefore, determining the effectiveness of SARS-CoV-2 vaccines in the setting of immunosuppression is essential to risk-stratify CID patients with impaired protection and provide clinical guidance regarding medication management.
We conducted a prospective assessment of mRNA-based vaccine immunogenicity in 133 adults with CIDs and 53 immunocompetent controls. Blood from participants over 18 years of age was collected before initial immunization and 1-2 weeks after the second immunization. Serum anti-SARS-CoV-2 spike (S) IgG+ binding, neutralizing antibody titers, and circulating S-specific plasmablasts were quantified to assess the magnitude and quality of the humoral response following vaccination.
Compared to immunocompetent controls, a three-fold reduction in anti-S IgG titers (P=0.009) and SARS-CoV-2 neutralization (p<0.0001) were observed in CID patients. B cell depletion and glucocorticoids exerted the strongest effect with a 36- and 10-fold reduction in humoral responses, respectively (p<0.0001). Janus kinase inhibitors and antimetabolites, including methotrexate, also blunted antibody titers in multivariate regression analysis (P<0.0001, P=0.0023, respectively). Other targeted therapies, such as TNF inhibitors, IL-12/23 inhibitors, and integrin inhibitors, had only modest impacts on antibody formation and neutralization.
CID patients treated with immunosuppressive therapies exhibit impaired SARS-CoV-2 vaccine-induced immunity, with glucocorticoids and B cell depletion therapy more severely impeding optimal responses. Specific analyses to SLE are currently underway.
To investigate sex-related differences in coronavirus disease 2019 (COVID-19) prognosis of patients affected by systemic lupus erythematosus (SLE).
We analyzed the data of the national surveillance study promoted by the Italian Society for Rheumatology (CONTROL-19 database) including patients with RMD and COVID-19(molecular diagnosis for SARS-CoV-2). The main objective of the analysis was the combined outcome death or mechanical ventilation. To evaluate the differences between male and female patients, categorical variable were analysed using either the Pearson’s Chi-squared test or the Fisher’s exact test, while quantitative variables were examined using Mann-Whitney test.
We included 80 patients with SLE (86.25% F, mean age 50.2 years, 53.8% active disease). Compared to women, men more often reported anosmia (54.5 vs 30.2%), dysgeusia (36.4 vs 30.6%), death (9.1 vs 4.3%), and combined outcome (9.1 vs 4.3%). Women were more often affected by abdominal pain (12.3 vs 0%), diarrhoea (24.2 vs 18.2%), nausea/vomiting (15.2 vs 0%), headache (38.8 vs 18.2%), pneumonia (26.9 vs 18.2%), more often were hospitalized (33.3 vs 27.3%), and required mechanical ventilation (1.4 vs 0%). All these differences did not reach statistical significance, probably due to the low number of patients studied.
Although our sample is too small to obtain significative differences and draw definitive conclusions, our data suggest that among lupus patients affected by COVID-19 men have a worse prognosis, even if women more often underwent hospitalization and mechanical ventilation.