Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: Systematic review and meta-analysis.

Autor: Jena A; Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Mishra S; Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Deepak P; Inflammatory Bowel Diseases Center, Division of Gastroenterology,Washington University in Saint Louis School of Medicine, St. Louis, MO, USA. Electronic address: deepak.parakkal@wustl.edu., Kumar-M P; Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Sharma A; Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Patel YI; Department of Rheumatology, Hull University Teaching Hospitals NHS Trust, Hull, UK. Electronic address: yusuf.patel9@nhs.net., Kennedy NA; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. Electronic address: nick.kennedy1@nhs.net., Kim AHJ; Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: akim@wustl.edu., Sharma V; Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: sharma.vishal@pgimer.edu.in., Sebastian S; IBD Unit - Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK. Electronic address: shaji.sebastian4@nhs.net.
Jazyk: angličtina
Zdroj: Autoimmunity reviews [Autoimmun Rev] 2022 Jan; Vol. 21 (1), pp. 102927. Date of Electronic Publication: 2021 Aug 30.
DOI: 10.1016/j.autrev.2021.102927
Abstrakt: Objectives: The treatment for COVID-19 often utilizes immune-modulating drugs. These drugs are also used in immune mediated inflammatory diseases (IMIDs). We performed a systematic review about seroconversion after SARS-CoV-2 vaccination in patients with IMIDs and impact of various drugs on seroconversion rates.
Methods: Electronic databases were searched to identify relevant studies reporting seroconversion rates following SARS-CoV-2 vaccination in IMIDs. We calculated the pooled seroconversion rates after a single or two doses of vaccination, pooled seroconversion rates in patients with specific IMIDs, and rates in patients on various drugs/drug classes.
Results: Twenty-five studies were included in the systematic review. The pooled seroconversion rates after two doses of mRNA vaccination were higher (83.1, 95%CI: 74.9-89.0, I 2  = 90%) as compared to a single dose (69.3, 52.4-82.3, I 2  = 95%). The odds of seroconversion were lower in IMIDs as compared to healthy controls (0.05, 0.02-0.13, I 2  = 21%). The seroconversion rates in patients with inflammatory bowel disease (95.2, 95%CI: 92.6-96.9, I 2  = 0%), spondyloarthropathy (95.6, 95% CI: 83.4-98.9, I 2  = 35%), and systemic lupus erythematosus (90.7, 95%CI: 85.4-94.2, I 2  = 0%) were higher as compared to rheumatoid arthritis (79.5, 95% CI: 65.1-88.9, I 2  = 85%), and vasculitis (70.5, 95% CI: 52.9-83.5, I 2  = 51%). The seroconversion rates following double dose of mRNA were excellent (>90%) in those on anti-tumour necrosis factor (TNF), anti-integrin (vedolizumab), anti-IL 17 (secukinumab), anti-IL6 (Tocilizumab) and anti-IL12/23 (Ustekinumab) therapies but attenuated (<70%) in patients on anti-CD20 (Rituximab) or anti-cytotoxic T lymphocyte associated antigen (CTLA-4) therapies (Abatacept). The seroconversion rates were good (70-90%) with steroids, hydroxychloroquine, JAK inhibitors, mycophenolate mofetil and leflunomide. Combination of anti-TNF with immunomodulators (azathioprine, 6-meracptopurine, methotrexate) resulted in an attenuated vaccine response as compared to anti-TNF monotherapy.
Conclusion: Seroconversion rates after SARS-CoV-2 vaccination are lower in patients with IMIDs. Certain therapies (anti-TNF, anti-integrin, anti-IL 17, anti-IL6, anti-12/23) do not impact seroconversion rates while others (anti-CD20, anti-CTLA-4) result in poorer responses.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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