Strong response after fourth dose of mRNA COVID-19 vaccine in autoimmune rheumatic diseases patients with poor response to inactivated vaccine.

Autor:	Aikawa NE; Division of Rheumatology., Kupa LVK; Division of Rheumatology., Silva CA; Division of Rheumatology.; Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente., Saad CGS; Division of Rheumatology., Pasoto SG; Division of Rheumatology., Yuki EFN; Division of Rheumatology., Fusco SRG; Division of Rheumatology., Shinjo SK; Division of Rheumatology., Andrade DCO; Division of Rheumatology., Sampaio-Barros PD; Division of Rheumatology., Pereira RMR; Division of Rheumatology., Chasin ACS; Division of Rheumatology., Shimabuco AY; Division of Rheumatology., Luppino-Assad AP; Division of Rheumatology., Leon EP; Division of Rheumatology., Lopes MH; Infectious Disease Department., Antonangelo L; Central Laboratory Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil., Medeiros-Ribeiro AC; Division of Rheumatology., Bonfa E; Division of Rheumatology.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2022 Dec 23; Vol. 62 (1), pp. 480-485.
DOI:	10.1093/rheumatology/keac301
Abstrakt:	Objectives: To assess immunogenicity of a heterologous fourth dose of an mRNA (BNT162b2) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in autoimmune rheumatic diseases (ARD) patients with poor/non-response to inactivated vaccine (Sinovac-CoronaVac). Methods: A total of 164 ARD patients who were coronavirus disease 2019 (COVID-19) poor/non-responders (negative anti-SARS-CoV-2 S1/S2 IgG and/or neutralizing antibodies-NAb) to the third dose of Sinovac-CoronaVac received an additional heterologous dose of mRNA (BNT162b2) 3 months after last dose. IgG and NAb were evaluated before and after the fourth dose. Results: Significant increases were observed after the fourth dose in IgG (66.4 vs 95.1%, P < 0.001), NAb positivity (5.5 vs 83.5%, P < 0.001) and geometric mean titre (29.5 vs 215.8 AU/ml, P < 0.001), and 28 (17.1%) remained poor/non-responders. Patients with negative IgG after a fourth dose were more frequently under rituximab (P = 0.001). Negative NAb was associated with older age (P = 0.015), RA (P = 0.002), SSc (P = 0.026), LEF (P = 0.016) and rituximab use (P = 0.007). In multiple logistic regression analysis, prednisone dose ≥7.5 mg/day (OR = 0.34; P = 0.047), LEF (OR = 0.32, P = 0.036) and rituximab use (OR = 0.19, P = 0.022) were independently associated with negative NAb after the fourth vaccine dose. Conclusions: This is the largest study to provide evidence of a remarkable humoral response after the fourth dose of heterologous mRNA SARS-CoV-2 vaccination in ARD patients with poor/non-response to the third dose of an inactivated vaccine. We further identified that treatment, particularly rituximab and prednisone, impaired antibody response to this additional dose. Trial Registration: ClinicalTrials.gov, https://clinicaltrials.gov, CoronavRheum #NCT04754698. (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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