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Ocon AJ, Cooper S, Ramsey A, Mustafa S. Secondary Immunodeficiency and Vaccine Response in Rheumatoid and Psoriatic Arthritis on Immunosuppressive Medicines. Cureus 2024; 16:e66366. [PMID: 39246934 PMCID: PMC11380548 DOI: 10.7759/cureus.66366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 09/10/2024] Open
Abstract
Background Rheumatoid arthritis and psoriatic arthritis patients have dysregulated immune system parameters that may increase infection risk at baseline. In addition, treatment of these conditions with immunosuppressive medications may lead to the development of secondary immunodeficiency (SID). Our objective was to assess SID in a cohort on immunosuppressive medications. We hypothesized that SID is clinically detectable by assessing immune parameters and polysaccharide and protein-based vaccination responses. Methodology A prospective cohort study of 42 subjects on immunosuppressive medications was assessed. Analysis included immunoglobulin levels, lymphocyte subsets, and two-step response to diphtheria, tetanus, and 23-valent Streptococcus pneumoniae vaccinations. Exclusions included primary immunodeficiency, malignancy, pregnancy, neutropenia, immunoglobulin replacement, prior B-cell-depleting medication or chemotherapy, use of non-immunosuppressive medication, or recent use of glucocorticoids. Suboptimal vaccine response was defined as an abnormal response based on standard criteria for each vaccine. Results Low IgM levels (below 50 mg/dL) occurred in seven (17%) subjects and IgG (below 650 mg/dL) in three (7%) subjects. Impaired lymphocyte subsets were uncommon. In total, 33 (78%) subjects completed the two-step vaccination assessment. Overall, 29 of 33 (88%) subjects demonstrated suboptimal response to pneumococcal vaccination, 10 (30%) demonstrated suboptimal response to diphtheria, and four (12%) to tetanus. Two (6%) subjects demonstrated suboptimal response to all vaccinations. Finally, 31 (94%) subjects demonstrated suboptimal response to at least one vaccination. Conclusions SID may develop, is clinically detectable, and most notably demonstrated in suboptimal responses to polysaccharide vaccinations, especially against S. pneumoniae.
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Affiliation(s)
- Anthony J Ocon
- Rheumatology, Rochester Regional Health, Rochester, USA
- Rheumatology, University of Rochester Medical School, Rochester, USA
| | - Shiamak Cooper
- Internal Medicine, Rochester Regional Health, Rochester, USA
| | - Allison Ramsey
- Allergy and Immunology, Rochester Regional Health, Rochester, USA
- Allergy and Immunology, University of Rochester Medical School, Rochester, USA
| | - Shahzad Mustafa
- Allergy and Immunology, Rochester Regional Health, Rochester, USA
- Allergy and Immunology, University of Rochester Medical School, Rochester, USA
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2
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Gallardo-Nelson MJ, Cruces M, Gómez YM, Fuenzalida C, Silva J, Aravena-Traipi L, Nuñez E, Gaete-Angel A, Rivas-Yañez E, Kalergis AM, Soto-Rifo R, Valiente-Echeverria F. 4th booster-dose SARS-CoV-2 heterologous and homologous vaccination in rheumatological patients. Front Immunol 2024; 15:1427501. [PMID: 39131157 PMCID: PMC11309998 DOI: 10.3389/fimmu.2024.1427501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/08/2024] [Indexed: 08/13/2024] Open
Abstract
Objective to evaluate the immune response to the SARS-CoV-2 vaccines in adults with immune-mediated rheumatic diseases (IMRDs) in comparison to healthy individuals, observed 1-20 weeks following the fourth vaccine dose. Additionally, to evaluate the impact of immunosuppressive therapies, vaccination schedules, the time interval between vaccination and sample collection on the vaccine's immune response. Methods We designed a longitudinal observational study conducted at the rheumatology department of Hospital de Copiapó. Neutralizing antibodies (Nabs) titers against the Wuhan and Omicron variant were analyzed between 1-20 weeks after administration of the fourth dose of the SARS-CoV-2 vaccine to 341 participants (218 IMRD patients and 123 healthy controls). 218 IMRD patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), systemic vasculitis (VS) and systemic scleroderma (SS) were analyzed. Results Performing a comparison between the variants, Wuhan vs Omicron, we noticed that there were significant differences (p<0.05) in the level of the ID50, both for healthy controls and for patients with IMRDs. The humoral response of patients with IMRDs is significantly lower compared to healthy controls for the Omicron variant of SARS-CoV-2 (p = 0.0015). The humoral response of patients with IMRDs decreases significantly when the time interval between vaccination and sample collection is greater than 35 days. This difference was observed in the response, both for the Wuhan variant and for the Omicron variant. Conclusion The IMRDs patients, the humoral response variation in the SARS-CoV-2 vaccine depends on doses and type of vaccine administered, the humoral response times and the treatment that these patients are receiving.
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Affiliation(s)
| | - Marcos Cruces
- Policlínico Reumatología e Inmunología, Hospital Regional de Copiapó, Copiapó, Chile
| | - Yolanda M. Gómez
- Departamento de Estadística, Facultad de Ciencias, Universidad del Bío-Bío, Concepción, Chile
| | - Constanza Fuenzalida
- Policlínico Reumatología e Inmunología, Hospital Regional de Copiapó, Copiapó, Chile
| | - Javiera Silva
- Departamento de Medicina, Facultad de Medicina, Universidad de Atacama, Copiapó, Chile
| | - Laura Aravena-Traipi
- Departamento de Medicina, Facultad de Medicina, Universidad de Atacama, Copiapó, Chile
| | - Eduardo Nuñez
- Departamento de Medicina, Facultad de Medicina, Universidad de Atacama, Copiapó, Chile
| | - Aracelly Gaete-Angel
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Elizabeth Rivas-Yañez
- Departamento de Medicina, Facultad de Medicina, Universidad de Atacama, Copiapó, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
- Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Soto-Rifo
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Fernando Valiente-Echeverria
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
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Kwiatkowska B, Krajewska-Włodarczyk M, Batko B, Maślińska M, Stajszczyk M, Świerkot J, Wiland P, Żuber Z, Tomasiewicz K. COVID-19 prophylaxis, diagnostics, and treatment in patients with rheumatic diseases. The Polish experts panel opinion. Reumatologia 2024; 62:4-17. [PMID: 38558893 PMCID: PMC10979375 DOI: 10.5114/reum/183469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolves, infection management in vulnerable populations requires formalized guidance. Although low-virulence variants of SARS-CoV-2 remain predominant, they pose an increased risk of severe illness in adults with rheumatic and musculoskeletal diseases (RMDs). Several disease-specific (chronic long-grade inflammation, concomitant immunosuppression) and individual (advanced age, multimorbidity, pregnancy, vaccination status) factors contribute to excess risk in RMD populations. Various post-COVID-19 manifestations are also increasingly reported and appear more commonly than in the general population. At a pathogenetic level, complex interplay involving innate and acquired immune dysregulation, viral persistence, and genetic predisposition shapes a unique susceptibility profile. Moreover, incident cases of SARS-CoV-2 infection as a trigger factor for the development of autoimmune conditions have been reported. Vaccination remains a key preventive strategy, and encouraging active education and awareness will be crucial for rheumatologists in the upcoming years. In patients with RMDs, COVID-19 vaccines' benefits outweigh the risks. Derivation of specialized diagnostic and therapeutic protocols within a comprehensive COVID-19 care plan represents an ideal scenario for healthcare system organization. Vigilance for symptoms of infection and rapid diagnosis are key for introducing antiviral treatment in patients with RMDs in a timely manner. This review provides updated guidance on optimal immunization, diagnosis, and antiviral treatment strategies.
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Affiliation(s)
- Brygida Kwiatkowska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Maria Maślińska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustron, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Zbigniew Żuber
- Department of Rheumatology, St. Louis Voivodeship Specialist Children’s Hospital, Krakow, Poland
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Venkat R, Wallace ZS, Sparks JA. Considerations for Pharmacologic Management of Rheumatoid Arthritis in the COVID-19 Era: a Narrative Review. Curr Rheumatol Rep 2023; 25:236-245. [PMID: 37597102 DOI: 10.1007/s11926-023-01111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE OF REVIEW To review the impact of disease-modifying antirheumatic drugs (DMARDs) on COVID-19 severity and vaccine immunogenicity and to discuss COVID-19 outcomes in patients with rheumatoid arthritis (RA). RECENT FINDINGS Rituximab is associated with severe COVID-19 and impaired vaccine immunogenicity via its B cell-depleting mechanism. JAK inhibitors and glucocorticoids have been modestly associated with severe COVID-19 and impaired vaccine immunogenicity. TNF inhibitors may have a protective effect against severe COVID-19 and do not appear to affect vaccine immunogenicity. Clinical trials have shown improved seroconversion and antibody titers when methotrexate is held around vaccine doses, but this may yield increased risk of RA flare. Patients with RA are also impacted by DMARD disruption, RA flares, and post-acute sequelae of COVID-19 after COVID-19 infection. Given the risks of COVID-19, rituximab should be used with caution in RA. Holding methotrexate doses around COVID-19 vaccination improves immunogenicity but may increase RA flare risk.
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Affiliation(s)
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Clinical Epidemiology Program, Mongan Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Harvard Medical School, Boston, MA, USA.
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.
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Bindoli S, Baggio C, Galozzi P, Vesentini F, Doria A, Cosma C, Padoan A, Sfriso P. Autoinflammatory Diseases and COVID-19 Vaccination: Analysis of SARS-CoV-2 Anti-S-RBD IgG Levels in a Cohort of Patients Receiving IL-1 Inhibitors. J Clin Med 2023; 12:4741. [PMID: 37510856 PMCID: PMC10380649 DOI: 10.3390/jcm12144741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of the study was to evaluate the antibody response after COVID-19 vaccination in patients affected by systemic autoinflammatory diseases (SAID) undertaking IL-1 inhibitors (IL-1i) compared to healthy vaccinated controls (HC). The course of COVID-19 in vaccinated patients on IL-1i was also assessed. The serological response was evaluated in SAID patients using the CLIA MAGLUMI TM 2000 Plus test after the first vaccination cycle and the booster dose. Fifty-four fully vaccinated healthcare workers were enrolled as HCs. GraphPad Prism 8 software was used for statistical analysis. All patients developed an adequate antibody response. No differences were observed between the antibody titers of patients on IL-1i and those not on IL-1i, either after the first vaccination cycle or the booster dose (p = 0.99), and to HC (p = 0.99). With increasing age, a decrease in antibody production was assessed after the second vaccine in SAID (r = 0.67, p = 0.0003). In general, 11.6% of SAID patients had COVID-19 after receiving vaccination. None of them developed severe disease or experienced flares of their autoinflammatory disease. In conclusion, patients receiving IL-1i develop an antibody response comparable to HC. No side effects after vaccination were observed; IL-1i was continued before and after injections to avoid flare-ups.
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Affiliation(s)
- Sara Bindoli
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Chiara Baggio
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Paola Galozzi
- Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Filippo Vesentini
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Chiara Cosma
- Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Padoan
- Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
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Tedeschi SK, Solomon DH, Chen Y, Ellrodt J, Whelan MG, Stratton J, Hayashi K, Whiteman NB, Chen L, Adejoorin I, Marks KE, Gomez-Rivas E, Rao DA, Jonsson AH, Wesemann DR. Humoral and cellular immune responses in persons with rheumatoid arthritis after a third dose of mRNA COVID-19 vaccine. Semin Arthritis Rheum 2023; 59:152177. [PMID: 36796211 PMCID: PMC9911151 DOI: 10.1016/j.semarthrit.2023.152177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Disease-modifying anti-rheumatic drugs (DMARDs) that treat rheumatoid arthritis (RA) may reduce immune responses to COVID-19 vaccination. We compared humoral and cell-mediated immunity before and after a 3rd dose of mRNA COVID vaccine in RA subjects. METHODS RA patients that received 2 doses of mRNA vaccine enrolled in an observational study in 2021 before receiving a 3rd dose. Subjects self-reported holding or continuing DMARDs. Blood samples were collected pre- and 4 weeks after the 3rd dose. 50 healthy controls provided blood samples. Humoral response was measured with in-house ELISA assays for anti-Spike IgG (anti-S) and anti-receptor binding domain IgG (anti-RBD). T cell activation was measured after stimulation with SARS-CoV-2 peptide. Spearman's correlations assessed the relationship between anti-S, anti-RBD, and frequencies of activated T cells. RESULTS Among 60 subjects, mean age was 63 years and 88% were female. 57% of subjects held at least 1 DMARD around the 3rd dose. 43% (anti-S) and 62% (anti-RBD) had a normal humoral response at week 4, defined as ELISA within 1 standard deviation of the healthy control mean. No differences in antibody levels were observed based on holding DMARDs. Median frequency of activated CD4 T cells was significantly greater post- vs. pre-3rd dose. Changes in antibody levels did not correlate with change in frequency of activated CD4 T cells. CONCLUSION Virus-specific IgG levels significantly increased in RA subjects using DMARDs after completing the primary vaccine series, though fewer than two-thirds achieved a humoral response like healthy controls. Humoral and cellular changes were not correlated.
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Affiliation(s)
- Sara K Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States.
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Yuezhou Chen
- Department of Medicine, Harvard Medical School, Boston, MA, United States; Division of Allergy and Immunology, Division of Genetics, Brigham and Women's Hospital, Boston, MA, United States
| | - Jack Ellrodt
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Mary Grace Whelan
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Jacklyn Stratton
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Keigo Hayashi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Noah Benjamin Whiteman
- Division of Allergy and Immunology, Division of Genetics, Brigham and Women's Hospital, Boston, MA, United States
| | - Lin Chen
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Ifeoluwakiisi Adejoorin
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Kathryne E Marks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Emma Gomez-Rivas
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - A Helena Jonsson
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Duane R Wesemann
- Department of Medicine, Harvard Medical School, Boston, MA, United States; Division of Allergy and Immunology, Division of Genetics, Brigham and Women's Hospital, Boston, MA, United States; Ragon Institute of MGH, MIT, and Harvard, United States
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