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van den Dijssel J, Duurland MC, Konijn VA, Kummer LY, Hagen RR, Kuijper LH, Wieske L, van Dam KP, Stalman EW, Steenhuis M, Geerdes DM, Mok JY, Kragten AH, Menage C, Koets L, Veldhuisen B, Verstegen NJ, van der Schoot CE, van Esch WJ, D'Haens GR, Löwenberg M, Volkers AG, Rispens T, Kuijpers TW, Eftimov F, van Gisbergen KP, van Ham SM, Ten Brinke A, van de Sandt CE. mRNA-1273 vaccinated inflammatory bowel disease patients receiving TNF inhibitors develop broad and robust SARS-CoV-2-specific CD8 + T cell responses. J Autoimmun 2024; 144:103175. [PMID: 38387105 DOI: 10.1016/j.jaut.2024.103175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024]
Abstract
SARS-CoV-2-specific CD8+ T cells recognize conserved viral peptides and in the absence of cross-reactive antibodies form an important line of protection against emerging viral variants as they ameliorate disease severity. SARS-CoV-2 mRNA vaccines induce robust spike-specific antibody and T cell responses in healthy individuals, but their effectiveness in patients with chronic immune-mediated inflammatory disorders (IMIDs) is less well defined. These patients are often treated with systemic immunosuppressants, which may negatively affect vaccine-induced immunity. Indeed, TNF inhibitor (TNFi)-treated inflammatory bowel disease (IBD) patients display reduced ability to maintain SARS-CoV-2 antibody responses post-vaccination, yet the effects on CD8+ T cells remain unclear. Here, we analyzed the impact of IBD and TNFi treatment on mRNA-1273 vaccine-induced CD8+ T cell responses compared to healthy controls in SARS-CoV-2 experienced and inexperienced patients. CD8+ T cells were analyzed for their ability to recognize 32 SARS-CoV-2-specific epitopes, restricted by 10 common HLA class I allotypes using heterotetramer combinatorial coding. This strategy allowed in-depth ex vivo profiling of the vaccine-induced CD8+ T cell responses using phenotypic and activation markers. mRNA vaccination of TNFi-treated and untreated IBD patients induced robust spike-specific CD8+ T cell responses with a predominant central memory and activated phenotype, comparable to those in healthy controls. Prominent non-spike-specific CD8+ T cell responses were observed in SARS-CoV-2 experienced donors prior to vaccination. Non-spike-specific CD8+ T cells persisted and spike-specific CD8+ T cells notably expanded after vaccination in these patient cohorts. Our data demonstrate that regardless of TNFi treatment or prior SARS-CoV-2 infection, IBD patients benefit from vaccination by inducing a robust spike-specific CD8+ T cell response.
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Affiliation(s)
- Jet van den Dijssel
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Mariël C Duurland
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Veronique Al Konijn
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Yl Kummer
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ruth R Hagen
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Lisan H Kuijper
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Koos Pj van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Juk Yee Mok
- Sanquin Reagents B.V., Amsterdam, Netherlands
| | | | - Charlotte Menage
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lianne Koets
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; National Screening Laboratory of Sanquin, Research and Laboratory Services, Amsterdam, Netherlands
| | - Barbera Veldhuisen
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Niels Jm Verstegen
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | | | - Geert Ram D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Klaas Pjm van Gisbergen
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - S Marieke van Ham
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Netherlands
| | - Anja Ten Brinke
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Carolien E van de Sandt
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
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2
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Valk AM, Keijser JBD, van Dam KPJ, Stalman EW, Wieske L, Steenhuis M, Kummer LYL, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Horváth B, Hijnen DJ, Schreurs CRG, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink GJ, Keijzer S, Derksen NIL, van Deelen M, van Mierlo G, Kuijpers TW, Eftimov F, van Ham SM, Ten Brinke A, Rispens T. Suppressed IgG4 class switching in dupilumab- and TNF inhibitor-treated patients after mRNA vaccination. Allergy 2024. [PMID: 38439527 DOI: 10.1111/all.16089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The noninflammatory immunoglobulin G4 (IgG4) is linked to tolerance and is unique to humans. Although poorly understood, prolonged antigenic stimulation and IL-4-signaling along the T helper 2-axis may be instrumental in IgG4 class switching. Recently, repeated SARS-CoV-2 mRNA vaccination has been linked to IgG4 skewing. Although widely used immunosuppressive drugs have been shown to only moderately affect humoral responses to SARS-CoV-2 mRNA vaccination, the effect on IgG4 switching has not been investigated. METHODS Here we study the impact of such immunosuppressive drugs, including the IL-4 receptor-blocking antibody dupilumab, on IgG4 skewing upon repeated SARS-CoV-2 mRNA vaccination. Receptor-binding domain (RBD) specific antibody responses were longitudinally measured in 600 individuals, including patients with immune-mediated inflammatory diseases treated with a TNF inhibitor (TNFi) and/or methotrexate (MTX), dupilumab, and healthy/untreated controls, after repeated mRNA vaccination. RESULTS We observed a substantial increase in the proportion of RBD-specific IgG4 antibodies (median 21%) in healthy/untreated controls after third vaccination. This IgG4 skewing was profoundly reduced in dupilumab-treated patients (<1%). Unexpectedly, an equally strong suppression of IgG4 skewing was observed in TNFi-treated patients (<1%), whereas MTX caused a modest reduction (7%). RBD-specific total IgG levels were hardly affected by these immunosuppressive drugs. Minimal skewing was observed, when primary vaccination was adenoviral vector-based. CONCLUSIONS Our results imply a critical role for IL-4/IL-13 as well as TNF in vivo IgG4 class switching. These novel findings advance our understanding of IgG4 class switch dynamics, and may benefit humoral tolerance induction strategies, treatment of IgG4 pathologies and mRNA vaccine optimization.
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Affiliation(s)
- Anika M Valk
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Jim B D Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Laura Y L Kummer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, UMCG Expertise Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Gerrit J Wolbink
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Ninotska I L Derksen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Melanie van Deelen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gerard van Mierlo
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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3
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van Kempen ZLE, van Dam KPJ, Keijser JBD, Stalman EW, Kummer LYL, Strijbis EMM, Steenhuis M, ten Brinke A, van Ham SM, Kuijpers T, Rispens T, Eftimov F, Wieske L, Killestein J. Longitudinal increase of humoral responses after four SARS-CoV-2 vaccinations and infection in MS patients on fingolimod. Mult Scler 2024; 30:443-447. [PMID: 37942812 PMCID: PMC10935618 DOI: 10.1177/13524585231207761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Humoral responses after SARS-CoV-2 vaccination are greatly impaired in multiple sclerosis (MS) patients on fingolimod. Effects of repeated vaccination and infections on long-term responses are unclear. METHODS Prospective study in 60 MS patients on fingolimod measuring humoral responses after up to four vaccinations and 8 months after fourth vaccination. RESULTS Anti-WH1 antibody titers increased with each additional vaccination. At long-term follow-up titers increased further and most patients developed new humoral responses against the BA.1 omicron variant. CONCLUSION Repeated SARS-CoV-2 vaccinations boost humoral immunity and, probably together with SARS-CoV-2 infections, induce humoral responses on the long-term in almost all patients.
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Affiliation(s)
- Zoé LE van Kempen
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Koos PJ van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jim BD Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura YL Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eva MM Strijbis
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
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4
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Keijzer S, Oskam N, Ooijevaar-de Heer P, Steenhuis M, Keijser JB, Wieske L, van Dam KP, Stalman EW, Kummer LY, Boekel L, Kuijpers TW, ten Brinke A, van Ham SM, Eftimov F, Tas SW, Wolbink GJ, Rispens T. Longitudinal rheumatoid factor autoantibody responses after SARS-CoV-2 vaccination or infection. Front Immunol 2024; 15:1314507. [PMID: 38487524 PMCID: PMC10937420 DOI: 10.3389/fimmu.2024.1314507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Background Rheumatoid factors (RFs) are autoantibodies that target the Fc region of IgG, and are found in patients with rheumatic diseases as well as in the healthy population. Many studies suggest that an immune trigger may (transiently) elicit RF responses. However, discrepancies between different studies make it difficult to determine if and to which degree RF reactivity can be triggered by vaccination or infection. Objective We quantitatively explored longitudinal RF responses after SARS-CoV-2 vaccination and infection in a well-defined, large cohort using a dual ELISA method that differentiates between true RF reactivity and background IgM reactivity. In addition, we reviewed existing literature on RF responses after vaccination and infection. Methods 151 healthy participants and 30 RA patients were included to measure IgM-RF reactivity before and after SARS-CoV-2 vaccinations by ELISA. Additionally, IgM-RF responses after a SARS-CoV-2 breakthrough infection were studied in 51 healthy participants. Results Published prevalence studies in subjects after infection report up to 85% IgM-RF seropositivity. However, seroconversion studies (both infection and vaccination) report much lower incidences of 2-33%, with a trend of lower percentages observed in larger studies. In the current study, SARS-CoV-2 vaccination triggered low-level IgM-RF responses in 5.5% (8/151) of cases, of which 1.5% (2/151) with a level above 10 AU/mL. Breakthrough infection was accompanied by development of an IgM-RF response in 2% (1/51) of cases. Conclusion Our study indicates that de novo RF induction following vaccination or infection is an uncommon event, which does not lead to RF epitope spreading.
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Affiliation(s)
- Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Nienke Oskam
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Pleuni Ooijevaar-de Heer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Jim B.D. Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Koos P.J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Y.L. Kummer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W. Tas
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Gerrit J. Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
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5
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van Dam KPJ, Volkers AG, Wieske L, Stalman EW, Kummer LYL, van Kempen ZLE, Killestein J, Tas SW, Boekel L, Wolbink GJ, van der Kooi AJ, Raaphorst J, Takkenberg RB, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Sanchez AP, van Els CACM, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart RCF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, van der Pol WL, Goedee HS, Steenhuis M, Keijzer S, Keijser JBD, Cristianawati O, Ten Brinke A, Verstegen NJM, van Ham SM, Rispens T, Kuijpers TW, Löwenberg M, Eftimov F. Primary SARS-CoV-2 infection in patients with immune-mediated inflammatory diseases: long-term humoral immune responses and effects on disease activity. BMC Infect Dis 2023; 23:332. [PMID: 37198536 DOI: 10.1186/s12879-023-08298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/29/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressants (ISPs) may have impaired long-term humoral immune responses and increased disease activity after SARS-CoV-2 infection. We aimed to investigate long-term humoral immune responses against SARS-CoV-2 and increased disease activity after a primary SARS-CoV-2 infection in unvaccinated IMID patients on ISPs. METHODS IMID patients on active treatment with ISPs and controls (i.e. IMID patients not on ISP and healthy controls) with a confirmed SARS-CoV-2 infection before first vaccination were included from an ongoing prospective cohort study (T2B! study). Clinical data on infections and increased disease activity were registered using electronic surveys and health records. A serum sample was collected before first vaccination to measure SARS-CoV-2 anti-receptor-binding domain (RBD) antibodies. RESULTS In total, 193 IMID patients on ISP and 113 controls were included. Serum samples from 185 participants were available, with a median time of 173 days between infection and sample collection. The rate of seropositive IMID patients on ISPs was 78% compared to 100% in controls (p < 0.001). Seropositivity rates were lowest in patients on anti-CD20 (40.0%) and anti-tumor necrosis factor (TNF) agents (60.5%), as compared to other ISPs (p < 0.001 and p < 0.001, respectively). Increased disease activity after infection was reported by 68 of 260 patients (26.2%; 95% CI 21.2-31.8%), leading to ISP intensification in 6 out of these 68 patients (8.8%). CONCLUSION IMID patients using ISPs showed reduced long-term humoral immune responses after primary SARS-CoV-2 infection, which was mainly attributed to treatment with anti-CD20 and anti-TNF agents. Increased disease activity after SARS-CoV-2 infection was reported commonly, but was mostly mild. TRIAL REGISTRATION NL74974.018.20, Trial ID: NL8900. Registered on 9 September 2020.
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Affiliation(s)
- Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Gerrit J Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Agner Parra Sanchez
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Faculty of Veterinary Medicine, Utrecht University Utrecht, Utrecht, The Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée C F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology section, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, the Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, the Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jim B D Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Niels J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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6
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van Kempen ZLE, Stalman EW, Steenhuis M, Kummer LYL, van Dam KPJ, Wilbrink MF, Ten Brinke A, van Ham SM, Kuijpers T, Rispens T, Eftimov F, Wieske L, Killestein J. SARS-CoV-2 omicron breakthrough infections in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:280-283. [PMID: 36564175 DOI: 10.1136/jnnp-2022-330100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/06/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is unclear which patients with multiple sclerosis (MS) are most susceptible for omicron breakthrough infections. METHODS We assessed omicron breakthrough infections in vaccinated patients with MS with and without disease-modifying therapies enrolled in an ongoing large prospective study. We longitudinally studied humoral responses after primary and booster vaccinations and breakthrough infections. RESULTS Omicron breakthrough infections were reported in 110/312 (36%) patients with MS, and in 105/110 (96%) infections were mild. Omicron breakthrough infections occurred more frequently in patients treated with anti-CD20 therapies and sphingosine-1 phosphate receptor (S1PR) modulators, patients with impaired humoral responses after primary immunisation (regardless of treatment) and patients without prior SARS-CoV-2 infections. After infection, antibody titres increased in patients on S1PR modulator treatment while anti-CD20 treated patients did not show an increase. CONCLUSIONS SARS-COV-2 omicron breakthrough infections are more prevalent in patients with MS on anti-CD20 therapies and S1PR modulators compared with other patients with MS, which correlated with decreased humoral responses after vaccination. Humoral responses after infection were higher in S1PR modulator-treated patients in comparison to patients on anti-CD20 therapies, suggesting that immunological protection from contracting infection or repeated exposures may differ between these therapies.
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Affiliation(s)
- Zoé L E van Kempen
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Laura Y L Kummer
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.,Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Koos P J van Dam
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Maarten F Wilbrink
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - S Marieke van Ham
- Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Swammerdam Insitute for Life Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Taco Kuijpers
- Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Filip Eftimov
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Luuk Wieske
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.,Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joep Killestein
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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7
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van Dam KP, Wieske L, Stalman EW, Kummer LY, Roosen J, van Kempen ZL, Killestein J, Volkers AG, Boekel L, Wolbink GJ, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GR, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Sanchez AP, van Els CA, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJ, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart RC, Teng YO, van Paassen P, Busch MH, Jallah PB, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CR, van der Pol W, Goedee HS, Steenhuis M, Keijzer S, Keijser JB, Cristianawati O, Rispens T, Brinke AT, Verstegen NJ, Marieke van Ham S, Tas SW, Kuijpers TW, Eftimov F. Disease activity in patients with immune-mediated inflammatory diseases after SARS-CoV-2 vaccinations. J Autoimmun 2023; 135:102984. [PMID: 36621174 PMCID: PMC9805902 DOI: 10.1016/j.jaut.2022.102984] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023]
Abstract
For patients with immune-mediated inflammatory diseases (IMIDs), concerns exist about increased disease activity after vaccination. We aimed to assess changes in disease activity after SARS-CoV-2 vaccination in patients with IMIDs, and determine risk factors for increased disease activity. In this substudy of a prospective observational cohort study (Target-to-B!), we included patients with IMIDs who received a SARS-CoV-2 vaccine. Patients reported changes in disease activity on a five-point Likert scale every 60 days for up to twelve months after first vaccination. In case of self-reported increased activity, hospital records were screened whether the treating physician reported increased activity, and for potential intensification of immunosuppressive (ISP) treatment. Mixed models were used to study determinants for self-reported increased disease activity. In total, 2111 patients were included for analysis after primary immunization (mean age 49.7 years [SD 13.7], 1329/2111 (63.0%) female), from which 1266 patients for analysis after first additional vaccination. Increased disease activity at 60 days after start of primary immunization was reported by 223/2111 (10.6%). In 96/223 (43.0%) the increase was confirmed by the treating physician and in 36/223 (16.1%) ISP treatment was intensified. Increased disease activity at seven to 60 days after additional vaccination, was reported by 139/1266 (11.0%). Vaccinations were not temporally associated with self-reported increased disease activity. Conversely, increased disease activity before first vaccination, neuromuscular disease, and multiple sclerosis were associated. Altogether, self-reported increased disease activity after vaccination against SARS-CoV-2 was recorded in a minority of patients and was generally mild. Moreover, multivariate analyses suggest that disease related factors, but not vaccinations are the major determinants for self-reported increased disease activity.
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Affiliation(s)
- Koos P.J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Y.L. Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jesse Roosen
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Zoé L.E. van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Adriaan G. Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Gerrit J. Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Anneke J. van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R. Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Geert R.A.M. D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I. Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel W. Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annelie H. Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicoline F. Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Angela L. Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc L. Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederike J. Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexandre E. Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands,Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Cécile A.C.M. van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands,Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
| | | | - Annabel M. Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée C.F. Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Y.K. Onno Teng
- Centre of Expertise for Lupus, Vasculitis- and Complement-mediated Systemic Diseases, Department of Internal Medicine – Nephrology Section, Leiden University Medical Centre, Leiden, the Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthias H. Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Papay B.P. Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Pieter A. van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adája E. Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Corine R.G. Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W.Ludo van der Pol
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, the Netherlands
| | - H. Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, the Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jim B.D. Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Niels J.M. Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands,Swammerdam Institute for Life Sciences, University of Amsterdam, the Netherlands
| | - Sander W. Tas
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
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8
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Wieske L, Stalman EW, van Dam PJK, Kummer LY, Steenhuis M, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink G, Van der Kooi A, Raaphorst J, Löwenberg M, Takkenberg B, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl A, Broens B, Parra Sanchez A, van Els CACM, Wit JD, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen D, Schreurs CRG, Van der Pol WL, Goedee HS, Keijzer S, Keijser J, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Rispens T, Eftimov F. Persistence of seroconversion at 6 months following primary immunisation in patients with immune-mediated inflammatory diseases. Ann Rheum Dis 2023; 82:883-885. [PMID: 36720583 DOI: 10.1136/ard-2022-223464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - P J Koos van Dam
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Laura Y Kummer
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Zoe L E van Kempen
- Department of Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Department of Rheumatology, Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Anneke Van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Public Health and Epidemiology; Immunity and Infections, location Academic Medical Center, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Frederique J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Agner Parra Sanchez
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands.,Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jelle De Wit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,Center for Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Abraham Rutgers
- Rheumatology and Clinical Immunology, University Medical Center, Groningen, The Netherlands
| | - Karina de Leeuw
- Rheumatology and Clinical Immunology, University Medical Center, Groningen, The Netherlands
| | - Barbara Horváth
- Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Cornelia F Allaart
- Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Y K Onno Teng
- Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine/Devision of Clinical & Experimental Immunology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Rheumatology, Maastricht UMC+, Maastricht, The Netherlands.,Department of Nephrology and Clinical Immunology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | | | - Dirkjan Hijnen
- Department of Dermatology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - W Ludo Van der Pol
- Department of Neurology and Neurosurgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - Sofie Keijzer
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Jim Keijser
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Olvi Cristianawati
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Niels J M Verstegen
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Department of Pediatric Immunology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands
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9
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van Kempen ZLE, Hogenboom L, Toorop AA, Steenhuis M, Stalman EW, Kummer LYL, van Dam KPJ, Bloem K, ten Brinke A, van Ham SM, Kuijpers TW, Wolbink GJ, Loeff FC, Wieske L, Eftimov F, Rispens T, Strijbis EMM, Killestein J. Ocrelizumab Concentration Is a Good Predictor of SARS-CoV-2 Vaccination Response in Patients with Multiple Sclerosis. Ann Neurol 2023; 93:103-108. [PMID: 36250739 PMCID: PMC9874752 DOI: 10.1002/ana.26534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 02/05/2023]
Abstract
Ocrelizumab, an anti-CD20 monoclonal antibody, counteracts induction of humoral immune responses after severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccinations in patients with multiple sclerosis (MS). We aimed to assess if serum ocrelizumab concentration measured at the time of vaccination could predict the humoral response after SARS-CoV-2 vaccination. In 52 patients with MS, we found ocrelizumab concentration at the time of vaccination to be a good predictor for SARS-CoV-2 IgG anti-RBD titers after vaccination (comparable to B-cell count). As the course of ocrelizumab concentration may be predicted using pharmacokinetic models, this may be a superior biomarker to guide optimal timing for vaccinations in B-cell depleted patients with MS. ANN NEUROL 2023;93:103-108.
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Affiliation(s)
- Zoé L. E. van Kempen
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Laura Hogenboom
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Alyssa A. Toorop
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Maurice Steenhuis
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Laura Y. L. Kummer
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands,Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Koos P. J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Karien Bloem
- Sanquin Diagnostic ServicesSanquin LaboratoryAmsterdamThe Netherlands
| | - Anja ten Brinke
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands
| | - S. Marieke van Ham
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands,Swammerdam Institute for Life SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious DiseaseAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Gerrit J. Wolbink
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands,Department of RheumatologyAmsterdam Rheumatology and Immunology CenterAmsterdamThe Netherlands
| | - Floris C. Loeff
- Sanquin Diagnostic ServicesSanquin LaboratoryAmsterdamThe Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands,Department of Clinical NeurophysiologySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Theo Rispens
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands
| | - Eva M. M. Strijbis
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Joep Killestein
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
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10
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van Dam KPJ, Hogenboom L, Stalman EW, Kummer LYL, Steenhuis M, Keijser JBD, Brinke AT, van Ham SM, Kuijpers TW, Rispens T, Wieske L, Eftimov F, Strijbis EM, Killestein J, van Kempen ZLE. Longitudinal SARS-CoV-2 humoral response in MS patients with and without SARS-CoV-2 infection prior to vaccination. Front Neurol 2022; 13:1032830. [PMID: 36438945 PMCID: PMC9686308 DOI: 10.3389/fneur.2022.1032830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/21/2022] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, certain disease modifying therapies (DMTs) used in multiple sclerosis (MS), such as anti-CD20 therapies, have been associated with decreased humoral responses after SARS-CoV-2 vaccination. Hybrid immunity, referring to immunity after both vaccination and SARS-CoV-2 infection might increase humoral responses. METHODS This was a substudy of two prospective cohort studies on SARS-CoV-2 antibodies after SARS-CoV-2 infection and vaccination. RBD-specific IgG titers of patients with MS and healthy controls who had experienced SARS-CoV-2 infection prior to the first vaccination were compared with those patients and healthy controls without prior infection. Humoral responses were measured at various time points after SARS-CoV-2 infection in convalescent patients and all patients prior to the first vaccination, 28 days after the first vaccination, and 28 days after the second vaccination. RESULTS One hundred and two individuals [of which 34 patients with MS and DMTs (natalizumab or ocrelizumab), 30 patients without DMTs, and 38 healthy controls] were included. Fifty one of these individuals were convalescent. Median SARS-CoV-2 antibody titers were higher after the first vaccination in convalescent individuals compared with individuals without infection prior to vaccination. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers were comparable after the second vaccination in patients with MS with and without prior infection. However, in the convalescent ocrelizumab-treated patients, SARS-CoV-2 antibody titers did not increase after vaccinations. CONCLUSION In patients with MS without anti-CD20 therapies, SARS-CoV-2 infection before vaccination increases humoral responses after the first vaccination, similar to the healthy controls. In patients with MS treated with ocrelizumab (convalescent and non-convalescent), humoral responses remained low.
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Affiliation(s)
- Koos P. J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Hogenboom
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Y. L. Kummer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Jim B. D. Keijser
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location AMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eva M. Strijbis
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Zoé L. E. van Kempen
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
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11
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Stalman EW, Wieske L, van Dam KPJ, Kummer LY, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink GJ, Van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D’Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Parra Sanchez A, van Els CACM, Wit JD, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng OYK, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, Van der Pol WL, Goedee HS, Steenhuis M, Keijzer S, Keijser JBD, Boogaard A, Cristianawati O, ten Brinke A, Verstegen NJM, Zwinderman KAH, Rispens T, van Ham SM, Kuijpers TW, Eftimov F. Breakthrough infections with the SARS-CoV-2 omicron (B.1.1.529) variant in patients with immune-mediated inflammatory diseases. Ann Rheum Dis 2022; 81:1757-1766. [DOI: 10.1136/ard-2022-222904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022]
Abstract
ObjectivesTo compare the cumulative incidence and disease severity of reported SARS-CoV-2 omicron breakthrough infections between patients with immune-mediated inflammatory diseases (IMID) on immunosuppressants and controls, and to investigate determinants for breakthrough infections.MethodsData were used from an ongoing national prospective multicentre cohort study on SARS-CoV-2 vaccination responses in patients with IMID in the Netherlands (Target-to-B! (T2B!) study). Patients wih IMID on immunosuppressants and controls (patients with IMID not on immunosuppressants and healthy controls) who completed primary immunisation were included. The observation period was between 1 January 2022 and 1 April 2022, during which the SARS-CoV-2 omicron (BA.1 and BA.2 subvariant) was dominant. A SARS-CoV-2 breakthrough infection was defined as a reported positive PCR and/or antigen test at least 14 days after primary immunisation. A multivariate logistic regression model was used to investigate determinants.Results1593 patients with IMID on immunosuppressants and 579 controls were included. The cumulative incidence of breakthrough infections was 472/1593 (29.6%; 95% CI 27% to 32%) in patients with IMID on immunosuppressants and 181/579 (31.3%; 95% CI 28% to 35%) in controls (p=0.42). Three (0.5%) participants had severe disease. Seroconversion after primary immunisation (relative risk, RR 0.71; 95% CI 0.52 to 0.96), additional vaccinations (RR 0.61; 95% CI 0.49 to 0.76) and a prior SARS-CoV-2 infection (RR 0.60; 95% CI 0.48 to 0.75) were associated with decreased risk of breakthrough infection.ConclusionsThe cumulative incidence of reported SARS-CoV-2 omicron breakthrough infections was high, but similar between patients with IMID on immunosuppressants and controls, and disease severity was mostly mild. Additional vaccinations and prior SARS-CoV-2 infections may reduce the incidence of breakthrough infections.
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12
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Boekel L, Besten YR, Hooijberg F, Wartena R, Steenhuis M, Vogelzang E, Leeuw M, Atiqi S, Tas SW, Lems WF, van Ham SM, Eftimov F, Stalman EW, Wieske L, Kuijpers TW, Voskuyl AE, van Vollenhoven RF, Gerritsen M, Krieckaert C, Rispens T, Boers M, Nurmohamed MT, Wolbink G. SARS-CoV-2 breakthrough infections in patients with immune-mediated inflammatory diseases during the omicron dominant period. The Lancet Rheumatology 2022; 4:e747-e750. [PMID: 36034738 PMCID: PMC9398211 DOI: 10.1016/s2665-9913(22)00221-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Rosa Wartena
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Erik Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Willem F Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - S Marieke van Ham
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Charlotte Krieckaert
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Theo Rispens
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
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13
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Verstegen NJM, Hagen RR, van den Dijssel J, Kuijper LH, Kreher C, Ashhurst T, Kummer LYL, Steenhuis M, Duurland M, de Jongh R, de Jong N, van der Schoot CE, Bos AV, Mul E, Kedzierska K, van Dam KPJ, Stalman EW, Boekel L, Wolbink G, Tas SW, Killestein J, van Kempen ZLE, Wieske L, Kuijpers TW, Eftimov F, Rispens T, van Ham SM, ten Brinke A, van de Sandt CE. Immune dynamics in SARS-CoV-2 experienced immunosuppressed rheumatoid arthritis or multiple sclerosis patients vaccinated with mRNA-1273. eLife 2022; 11:e77969. [PMID: 35838348 PMCID: PMC9337853 DOI: 10.7554/elife.77969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients affected by different types of autoimmune diseases, including common conditions such as multiple sclerosis (MS) and rheumatoid arthritis (RA), are often treated with immunosuppressants to suppress disease activity. It is not fully understood how the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral and cellular immunity induced by infection and/or upon vaccination is affected by immunosuppressants. Methods The dynamics of cellular immune reactivation upon vaccination of SARS-CoV-2 experienced MS patients treated with the humanized anti-CD20 monoclonal antibody ocrelizumab (OCR) and RA patients treated with methotrexate (MTX) monotherapy were analyzed at great depth via high-dimensional flow cytometry of whole blood samples upon vaccination with the SARS-CoV-2 mRNA-1273 (Moderna) vaccine. Longitudinal B and T cell immune responses were compared to SARS-CoV-2 experienced healthy controls (HCs) before and 7 days after the first and second vaccination. Results OCR-treated MS patients exhibit a preserved recall response of CD8+ T central memory cells following first vaccination compared to HCs and a similar CD4+ circulating T follicular helper 1 and T helper 1 dynamics, whereas humoral and B cell responses were strongly impaired resulting in absence of SARS-CoV-2-specific humoral immunity. MTX treatment significantly delayed antibody levels and B reactivation following the first vaccination, including sustained inhibition of overall reactivation marker dynamics of the responding CD4+ and CD8+ T cells. Conclusions Together, these findings indicate that SARS-CoV-2 experienced MS-OCR patients may still benefit from vaccination by inducing a broad CD8+ T cell response which has been associated with milder disease outcome. The delayed vaccine-induced IgG kinetics in RA-MTX patients indicate an increased risk after the first vaccination, which might require additional shielding or alternative strategies such as treatment interruptions in vulnerable patients. Funding This research project was supported by ZonMw (The Netherlands Organization for Health Research and Development, #10430072010007), the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement (#792532 and #860003), the European Commission (SUPPORT-E, #101015756) and by PPOC (#20_21 L2506), the NHMRC Leadership Investigator Grant (#1173871).
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Affiliation(s)
- Niels JM Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Ruth R Hagen
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Jet van den Dijssel
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Lisan H Kuijper
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Christine Kreher
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Thomas Ashhurst
- Sydney Cytometry Core Research Facility, Charles Perkins Centre, Centenary Institute, and The University of SydneySydneyAustralia
- School of Medical Sciences, Faculty of Medicine and Health, The University of SydneySydneyAustralia
| | - Laura YL Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Mariel Duurland
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Rivka de Jongh
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Nina de Jong
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Amélie V Bos
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Erik Mul
- Department of Research Facilities, Sanquin ResearchAmsterdamNetherlands
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido UniversitySapporoJapan
| | - Koos PJ van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and immunology CenterAmsterdamNetherlands
| | - Gertjan Wolbink
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Rheumatology, Amsterdam Rheumatology and immunology CenterAmsterdamNetherlands
| | - Sander W Tas
- Amsterdam Rheumatology and immunology Center, Department of Rheumatology and Clinical Immunology, University of AmsterdamAmsterdamNetherlands
| | - Joep Killestein
- Amsterdam UMC, Vrije Universiteit, Department of NeurologyAmsterdamNetherlands
| | - Zoé LE van Kempen
- Amsterdam UMC, Vrije Universiteit, Department of NeurologyAmsterdamNetherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
- Department of Clinical Neurophysiology, St Antonius HospitalNieuwegeinNetherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, University of AmsterdamAmsterdamNetherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Swammerdam Institute for Life Sciences, University of AmsterdamAmsterdamNetherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Carolien E van de Sandt
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
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14
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Palomares Cabeza V, Kummer LYL, Wieske L, Hagen RR, Duurland M, Konijn VAL, van Dam KPJ, Stalman EW, van de Sandt CE, Boekel L, Verstegen NJM, Steenhuis M, Rispens T, Tas SW, Wolbink G, Killestein J, Kuijpers TW, van Ham SM, Eftimov F, Brinke AT, van Kempen ZLE. Longitudinal T-Cell Responses After a Third SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis on Ocrelizumab or Fingolimod. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/4/e1178. [PMID: 35523569 PMCID: PMC9082763 DOI: 10.1212/nxi.0000000000001178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate whether a third vaccination shows an added effect on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) T-cell responses in patients with multiple sclerosis treated with ocrelizumab or fingolimod. METHODS This is a substudy of a prospective multicenter study on SARS-CoV-2 vaccination in patients with immune-mediated diseases. Patients with MS treated with ocrelizumab, fingolimod, and no disease-modifying therapies and healthy controls were included. The number of interferon (IFN)-γ secreting SARS-CoV-2-specific T cells at multiple time points before and after 3 SARS-CoV-2 vaccinations were evaluated. RESULTS In ocrelizumab-treated patients (N = 24), IFN-γ-producing SARS-CoV-2-specific T-cell responses were induced after 2 vaccinations with median levels comparable to healthy controls (N = 12) and patients with MS without disease-modifying therapies (N = 10). A third vaccination in ocrelizumab-treated patients (N = 8) boosted T-cell responses that had declined after the second vaccination, but did not lead to higher overall T-cell responses as compared to immediately after a second vaccination. In fingolimod-treated patients, no SARS-CoV-2-specific T cells were detected after second (N = 12) and third (N = 9) vaccinations. DISCUSSION In ocrelizumab-treated patients with MS, a third SARS-CoV-2 vaccination had no additive effect on the maximal T-cell response but did induce a boost response. In fingolimod-treated patients, no T-cell responses could be detected following both a second and third SARS-CoV-2 vaccination.
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Affiliation(s)
- Virginia Palomares Cabeza
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Laura Y L Kummer
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands.
| | - Luuk Wieske
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Ruth R Hagen
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Mariel Duurland
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Veronique A L Konijn
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Koos P J van Dam
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Eileen W Stalman
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Carolien E van de Sandt
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Laura Boekel
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Niels J M Verstegen
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Maurice Steenhuis
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Theo Rispens
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Sander W Tas
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Gertjan Wolbink
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Joep Killestein
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Taco W Kuijpers
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - S Marieke van Ham
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Filip Eftimov
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Anja Ten Brinke
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Zoé L E van Kempen
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
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15
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Boekel L, Stalman EW, Wieske L, Hooijberg F, van Dam KPJ, Besten YR, Kummer LYL, Steenhuis M, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Parra Sanchez A, van Els CACM, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, van der Pol WL, Goedee HS, Vogelzang EH, Leeuw M, Atiqi S, van Vollenhoven R, Gerritsen M, van der Horst-Bruinsma IE, Lems WF, Nurmohamed MT, Boers M, Keijzer S, Keijser J, van de Sandt C, Boogaard A, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Rispens T, Kuijpers TW, Wolbink G, Eftimov F. Breakthrough SARS-CoV-2 infections with the delta (B.1.617.2) variant in vaccinated patients with immune-mediated inflammatory diseases using immunosuppressants: a substudy of two prospective cohort studies. The Lancet Rheumatology 2022; 4:e417-e429. [PMID: 35527808 PMCID: PMC9054068 DOI: 10.1016/s2665-9913(22)00102-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Concerns have been raised regarding the risks of SARS-CoV-2 breakthrough infections in vaccinated patients with immune-mediated inflammatory diseases treated with immunosuppressants, but clinical data on breakthrough infections are still scarce. The primary objective of this study was to compare the incidence and severity of SARS-CoV-2 breakthrough infections between patients with immune-mediated inflammatory diseases using immunosuppressants, and controls (patients with immune-mediated inflammatory diseases not taking immunosuppressants and healthy controls) who had received full COVID-19 vaccinations. The secondary objective was to explore determinants of breakthrough infections of the delta (B.1.617.2) variant of SARS-CoV-2, including humoral immune responses after vaccination. Methods In this substudy, we pooled data collected in two large ongoing prospective multicentre cohort studies conducted in the Netherlands (Target to-B! [T2B!] study and Amsterdam Rheumatology Center COVID [ARC-COVID] study). Both studies recruited adult patients (age ≥18 years) with immune-mediated inflammatory diseases and healthy controls. We sourced clinical data from standardised electronic case record forms, digital questionnaires, and medical files. We only included individuals who were vaccinated against SARS-CoV-2. For T2B!, participants were recruited between Feb 2 and Aug 1, 2021, and for ARC-COVID, participants were recruited between April 26, 2020, and March 1, 2021. In this study we assessed data on breakthrough infections collected between July 1 and Dec 15, 2021, a period in which the delta SARS-CoV-2 variant was the dominant variant in the Netherlands. We defined a SARS-CoV-2 breakthrough infection as a PCR-confirmed or antigen test-confirmed SARS-CoV-2 infection that occurred at least 14 days after vaccination. All breakthrough infections during this period were assumed to be due to the delta variant due to its dominance during the study period. We analysed post-vaccination serum samples for anti-receptor binding domain (RBD) antibodies to assess the humoral vaccination response (T2B! study only) and anti-nucleocapsid antibodies to identify asymptomatic breakthrough infections (ARC-COVID study only). We used multivariable logistic regression analyses to explore potential clinical and humoral determinants associated with the odds of breakthrough infections. The T2B! study is registered with the Dutch Trial Register, Trial ID NL8900, and the ARC-COVID study is registered with Dutch Trial Register, trial ID NL8513. Findings We included 3207 patients with immune-mediated inflammatory diseases who receive immunosuppressants, and 1807 controls (985 patients with immune-mediated inflammatory disease not on immunosuppressants and 822 healthy controls). Among patients receiving immunosuppressants, mean age was 53 years (SD 14), 2042 (64%) of 3207 were female and 1165 (36%) were male; among patients not receiving immunosuppressants, mean age was 54 years (SD 14), 598 (61%) of 985 were female and 387 (39%) were male; and among healthy controls, mean age was 57 years (SD 13), 549 (67%) of 822 were female and 273 (33%) were male. The cumulative incidence of PCR-test or antigen-test confirmed SARS-CoV-2 breakthrough infections was similar in patients on immunosuppressants (148 of 3207; 4·6% [95% CI 3·9–5·4]), patients not on immunosuppressants (52 of 985; 5·3% [95% CI 4·0–6·9]), and healthy controls (33 of 822; 4·0% [95% CI 2·8–5·6]). There was no difference in the odds of breakthrough infection for patients with immune-mediate inflammatory disease on immunosuppressants versus combined controls (ie, patients not on immunosuppressants and healthy controls; adjusted odds ratio 0·88 [95% CI 0·66–1·18]). Seroconversion after vaccination (odds ratio 0·58 [95% CI 0·34–0·98]; T2B! cohort only) and SARS-CoV-2 infection before vaccination (0·34 [0·18–0·56]) were associated with a lower odds of breakthrough infections. Interpretation The incidence and severity of SARS-CoV-2 breakthrough infections in patients with immune-mediated inflammatory diseases on immunosuppressants was similar to that in controls. However, caution might still be warranted for those on anti-CD20 therapy and those with traditional risk factors. Funding ZonMw (the Netherlands Organization for Health Research and Development) and Reade foundation.
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Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Zoé L E van Kempen
- Department of Neurology Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Annelie H Musters
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Nicoline F Post
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Angela L Bosma
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Groningen, Groningen, Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Groningen, Groningen, Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology section, Leiden University Medical Center, Leiden, Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - W Ludo van der Pol
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands
| | - H Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | | | - Willem F Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
| | - Sofie Keijzer
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Jim Keijser
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Carolien van de Sandt
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Arend Boogaard
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Olvi Cristianawati
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Anja Ten Brinke
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels J M Verstegen
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | | | - S Marieke van Ham
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
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16
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Wieske L, van Dam KPJ, Steenhuis M, Stalman EW, Kummer LYL, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink GJ, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Sanchez AP, van Els CACM, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart RCF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, van der Pol WL, Goedee HS, Keijzer S, Keijser JBD, Boogaard A, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Rispens T, Eftimov F. Humoral responses after second and third SARS-CoV-2 vaccination in patients with immune-mediated inflammatory disorders on immunosuppressants: a cohort study. The Lancet Rheumatology 2022; 4:e338-e350. [PMID: 35317410 PMCID: PMC8930018 DOI: 10.1016/s2665-9913(22)00034-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Disease-specific studies have reported impaired humoral responses after SARS-CoV-2 vaccination in patients with immune-mediated inflammatory disorders treated with specific immunosuppressants. Disease-overarching studies, and data on recall responses and third vaccinations are scarce. Our primary objective was to investigate the effects of immunosuppressive monotherapies on the humoral immune response after SARS-CoV-2 vaccination in patients with prevalent immune-mediated inflammatory disorders. Methods We did a cohort study in participants treated in outpatient clinics in seven university hospitals and one rheumatology treatment centre in the Netherlands as well as participants included in two national cohort studies on COVID-19-related disease severity. We included patients aged older than 18 years, diagnosed with any of the prespecified immune-mediated inflammatory disorders, who were able to understand and complete questionnaires in Dutch. Participants with immune-mediated inflammatory disorders who were not on systemic immunosuppressants and healthy participants were included as controls. Anti-receptor binding domain IgG responses and neutralisation capacity were monitored following standard vaccination regimens and a three-vaccination regimen in subgroups. Hybrid immune responses—ie, vaccination after previous SARS-CoV-2 infection—were studied as a proxy for recall responses. Findings Between Feb 2 and Aug 1, 2021, we included 3222 participants in our cohort. Sera from 2339 participants, 1869 without and 470 participants with previous SARS-CoV-2 infection were analysed (mean age 49·9 years [SD 13·7]; 1470 [62·8%] females and 869 [37·2%] males). Humoral responses did not differ between disorders. Anti-CD20 therapy, sphingosine 1-phosphate receptor (S1P) modulators, and mycophenolate mofetil combined with corticosteroids were associated with lower relative risks for reaching seroconversion following standard vaccination (0·32 [95% CI 0·19–0·49] for anti-CD20 therapy, 0·35 [0·21–0·55] for S1P modulators, and 0·61 [0·40–0·90] for mycophenolate mofetil combined with corticosteroids). A third vaccination increased seroconversion for mycophenolate mofetil combination treatments (from 52·6% after the second vaccination to 89·5% after the third) but not significantly for anti-CD20 therapies (from 36·8% to 45·6%) and S1P modulators (from 35·5% to 48·4%). Most other immunosuppressant groups showed moderately reduced antibody titres after standard vaccination that did not increase after a third vaccination, although seroconversion rates and neutralisation capacity were unaffected. In participants with previous SARS-CoV-2 infection, SARS-CoV-2 antibodies were boosted after vaccination, regardless of immunosuppressive treatment. Interpretation Humoral responses following vaccination are impaired by specific immunosuppressants. After standard vaccination regimens, patients with immune-mediated inflammatory disorders taking most immunosuppressants show similar seroconversion to controls, although antibody titres might be moderately reduced. As neutralisation capacity and recall responses are also preserved in these patients, this is not likely to translate to loss of (short-term) protection. In patients on immunosuppressants showing poor humoral responses after standard vaccination regimens, a third vaccination resulted in additional seroconversion in patients taking mycophenolate mofetil combination treatments, whereas the effect of a third vaccination in patients on anti-CD20 therapy and S1P modulators was limited. Funding ZonMw (The Netherlands Organization for Health Research and Development).
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Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Gerrit J Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Faculty of Veterinary Medicine, Utrecht University Utrecht, Utrecht, Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Renée C F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine, Nephrology Section, Leiden University Medical Center, Leiden, Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Jim B D Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Arend Boogaard
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam UMC and Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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17
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Boekel L, Hooijberg F, Vogelzang EH, Besten YR, Leeuw M, Atiqi S, van Vollenhoven RF, Wijbrandts CA, Gerritsen M, Krieckaert C, Dijkshoorn B, Bakhlakh S, Crooijmans JJ, Voskuyl A, van der Horst-Bruinsma IE, Lems W, Kuijpers TW, van Ham SM, Wieske L, Eftimov F, Kummer LY, van Dam PK, Stalman EW, Steenhuis M, Keijzer S, Cristianawati O, Keijser J, Loeff FC, Tas SW, Nurmohamed MT, Boers M, Rispens T, Wolbink G. Antibody development and disease severity of COVID-19 in non-immunised patients with rheumatic immune-mediated inflammatory diseases: data from a prospective cohort study. RMD Open 2022; 8:rmdopen-2021-002035. [PMID: 35383121 PMCID: PMC8983412 DOI: 10.1136/rmdopen-2021-002035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/10/2022] [Indexed: 02/07/2023] Open
Abstract
Background Research on the disease severity of COVID-19 in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) has been inconclusive, and long-term prospective data on the development of SARS-CoV-2 antibodies in these patients are lacking. Methods Adult patients with rheumatic IMIDs from the Amsterdam Rheumatology and Immunology Center, Amsterdam were invited to participate. All patients were asked to recruit their own sex-matched and age-matched control subject. Clinical data were collected via online questionnaires (at baseline, and after 1–4 and 5–9 months of follow-up). Serum samples were collected twice and analysed for the presence of SARS-CoV-2-specific antibodies. Subsequently, IgG titres were quantified in samples with a positive test result. Findings In total, 3080 consecutive patients and 1102 controls with comparable age and sex distribution were included for analyses. Patients were more frequently hospitalised compared with controls when infected with SARS-CoV-2; 7% vs 0.7% (adjusted OR: 7.33, 95% CI: 0.96 to 55.77). Only treatment with B-cell targeting therapy was independently associated with an increased risk of COVID-19-related hospitalisation (adjusted OR: 14.62, 95% CI: 2.31 to 92.39). IgG antibody titres were higher in hospitalised compared with non-hospitalised patients, and slowly declined with time in similar patterns for patients in all treatment subgroups and controls. Interpretation We observed that patients with rheumatic IMIDs, especially those treated with B-cell targeting therapy, were more likely to be hospitalised when infected with SARS-CoV-2. Treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs other than B-cell targeting agents is unlikely to have negative effects on the development of long-lasting humoral immunity against SARS-CoV-2.
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Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Carla A Wijbrandts
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - C Krieckaert
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Bas Dijkshoorn
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Siham Bakhlakh
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Juliette J Crooijmans
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Willem Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Laura Y Kummer
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Pj Koos van Dam
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Jim Keijser
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Floris C Loeff
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands.,Department of Epidemiology & Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
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18
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Wieske L, Kummer LYL, van Dam KPJ, Stalman EW, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, Volkers AG, D'Haens GRAM, Tas SW, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Killestein J, van Kempen ZLE, Voskuyl AE, Broens B, Sanchez AP, Wolbink G, Boekel L, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah BP, Brusse E, van Doorn PA, Baars AE, Hijnen D, Schreurs CRG, van der Pol WL, Goedee HS, Steenhuis M, Rispens T, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Eftimov F. Risk factors associated with short-term adverse events after SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseases. BMC Med 2022; 20:100. [PMID: 35236350 PMCID: PMC8889379 DOI: 10.1186/s12916-022-02310-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have suggested incremental short-term adverse events (AE) after repeated vaccination. In this report, we assessed occurrence and risk factors for short-term AEs following repeated SARS-CoV-2 vaccination in patients with various immune-mediated inflammatory diseases (IMIDs). METHODS Self-reported daily questionnaires on AEs during the first 7 days after vaccination were obtained of 2259 individuals (2081 patients and 178 controls) participating in an ongoing prospective multicenter cohort study on SARS-CoV-2 vaccination in patients with various IMIDs in the Netherlands (T2B-COVID). Relative risks were calculated for potential risk factors associated with clinically relevant AE (rAE), defined as AE lasting longer than 2 days or impacting daily life. RESULTS In total, 5454 vaccinations were recorded (1737 first, 1992 second and 1478 third vaccinations). Multiple sclerosis, Crohn's disease and rheumatoid arthritis were the largest disease groups. rAEs were reported by 57.3% (95% CI 54.8-59.8) of patients after the first vaccination, 61.5% (95% CI 59.2-63.7) after the second vaccination and 58% (95% CI 55.3-60.6) after the third vaccination. At day 7 after the first, second and third vaccination, respectively, 7.6% (95% CI 6.3-9.1), 7.4% (95% CI 6.2-8.7) and 6.8% (95% CI 5.4-8.3) of patients still reported AEs impacting daily life. Hospital admissions and allergic reactions were uncommon (<0.7%). Female sex (aRR 1.43, 95% CI 1.32-1.56), age below 50 (aRR 1.14, 95% CI 1.06-1.23), a preceding SARS-CoV-2 infection (aRR 1.14, 95% CI 1.01-1.29) and having an IMID (aRR 1.16, 95% CI 1.01-1.34) were associated with increased risk of rAEs following a vaccination. Compared to the second vaccination, the first vaccination was associated with a lower risk of rAEs (aRR 0.92, 95% CI 0.84-0.99) while a third vaccination was not associated with increased risk on rAEs (aRR 0.93, 95% CI 0.84-1.02). BNT162b2 vaccines were associated with lower risk on rAEs compared to CX-024414 (aRR 0.86, 95% CI 0.80-0.93). CONCLUSIONS A third SARS-CoV-2 vaccination was not associated with increased risk of rAEs in IMID patients compared to the second vaccination. Patients with an IMID have a modestly increased risk of rAEs after vaccination when compared to controls. Most AEs are resolved within 7 days; hospital admissions and allergic reactions were uncommon. TRIAL REGISTRATION NL74974.018.20 , Trial ID: NL8900. Registered on 9 September 2020.
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Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Public Health/Infection and Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology Section, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B Papay Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dirkjan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Niels J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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19
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van Kempen ZLE, Wieske L, Stalman EW, Kummer LYL, van Dam PJ, Volkers AG, Boekel L, Toorop AA, Strijbis EMM, Tas SW, Wolbink GJ, Löwenberg M, van Sandt C, Ten Brinke A, Verstegen NJM, Steenhuis M, Kuijpers TW, van Ham SM, Rispens T, Eftimov F, Killestein J. Longitudinal humoral response after SARS-CoV-2 vaccination in ocrelizumab treated MS patients: To wait and repopulate? Mult Scler Relat Disord 2021; 57:103416. [PMID: 34847379 PMCID: PMC8608662 DOI: 10.1016/j.msard.2021.103416] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to measure humoral responses after SARS-CoV-2 vaccination in MS patients treated with ocrelizumab (OCR) compared to MS patients without disease modifying therapies (DMTs) in relation to timing of vaccination and B-cell count. METHODS OCR treated patients were divided into an early and a late group (cut-off time 12 weeks between infusion and first vaccination). Patients were vaccinated with mRNA-1273 (Moderna). B-cells were measured at baseline (time of first vaccination) and SARS-CoV-2 antibodies were measured at baseline, day 28, 42, 52 and 70. RESULTS 87 patients were included (62 OCR patients, 29 patients without DMTs). At day 70, seroconversion occurred in 39.3% of OCR patients compared to 100% of MS patients without DMTs. In OCR patients, seroconversion varied between 26% (early group) to 50% (late group) and between 27% (low B-cells) to 56% (at least 1 detectable B-cell/µL). CONCLUSIONS Low B-cell counts prior to vaccination and shorter time between OCR infusion and vaccination may negatively influence humoral response but does not preclude seroconversion. We advise OCR treated patients to get their first vaccination as soon as possible. In case of an additional booster vaccination, timing of vaccination based on B-cell count and time after last infusion may be considered.
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Affiliation(s)
- Z L E van Kempen
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland.
| | - L Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - E W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - L Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - A G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - L Boekel
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, the Netherland
| | - A A Toorop
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland
| | - E M M Strijbis
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland
| | - S W Tas
- Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - G J Wolbink
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, the Netherland
| | - M Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - C van Sandt
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland; Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth, Melbourne, VIC 3000, USA
| | - A Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - N J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - M Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - T W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - S M van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland; Swammerdam Institute for Life Sciences, University of Amsterdam, the Netherland
| | - T Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - F Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - J Killestein
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland
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20
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Boekel L, Steenhuis M, Hooijberg F, Besten YR, van Kempen ZLE, Kummer LY, van Dam KPJ, Stalman EW, Vogelzang EH, Cristianawati O, Keijzer S, Vidarsson G, Voskuyl AE, Wieske L, Eftimov F, van Vollenhoven R, Kuijpers TW, van Ham SM, Tas SW, Killestein J, Boers M, Nurmohamed MT, Rispens T, Wolbink G. Antibody development after COVID-19 vaccination in patients with autoimmune diseases in the Netherlands: a substudy of data from two prospective cohort studies. Lancet Rheumatol 2021; 3:e778-e788. [PMID: 34396154 PMCID: PMC8346242 DOI: 10.1016/s2665-9913(21)00222-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Data are scarce on immunogenicity of COVID-19 vaccines in patients with autoimmune diseases, who are often treated with immunosuppressive drugs. We aimed to investigate the effect of different immunosuppressive drugs on antibody development after COVID-19 vaccination in patients with autoimmune diseases. Methods In this study, we used serum samples collected from patients with autoimmune diseases and healthy controls who were included in two ongoing prospective cohort studies in the Netherlands. Participants were eligible for inclusion in this substudy if they had been vaccinated with any COVID-19 vaccine via the Dutch national vaccine programme, which at the time was prioritising vaccination of older individuals. Samples were collected after the first or second COVID-19 vaccination. No serial samples were collected. Seroconversion rates and IgG antibody titres against the receptor-binding domain of the SARS-CoV-2 spike protein were measured. Logistic and linear regression analyses were used to investigate the association between medication use at the time of vaccination and at least until sampling, seroconversion rates, and IgG antibody titres. The studies from which data were collected are registered on the Netherlands Trial Register, Trial ID NL8513, and ClinicalTrials.org, NCT04498286. Findings Between April 26, 2020, and March 1, 2021, 3682 patients with rheumatic diseases, 546 patients with multiple sclerosis, and 1147 healthy controls were recruited to participate in the two prospective cohort studies. Samples were collected from patients with autoimmune diseases (n=632) and healthy controls (n=289) after their first (507 patients and 239 controls) or second (125 patients and 50 controls) COVID-19 vaccination. The mean age of both patients and controls was 63 years (SD 11), and 423 (67%) of 632 patients with autoimmune diseases and 195 (67%) of 289 controls were female. Among participants without previous SARS-CoV-2 infection, seroconversion after first vaccination were significantly lower in patients than in controls (210 [49%] of 432 patients vs 154 [73%] of 210 controls; adjusted odds ratio 0·33 [95% CI 0·23–0·48]; p<0·0001), mainly due to lower seroconversion in patients treated with methotrexate or anti-CD20 therapies. After the second vaccination, seroconversion exceeded 80% in all patient treatment subgroups, except among those treated with anti-CD20 therapies (three [43%] of seven patients). We observed no difference in seroconversion and IgG antibody titres between patients with a previous SARS-CoV-2 infection who had received a single vaccine dose (72 [96%] of 75 patients, median IgG titre 127 AU/mL [IQR 27–300]) and patients without a previous SARS-CoV-2 infection who had received two vaccine doses (97 [92%] of 106 patients, median IgG titre 49 AU/mL [17–134]). Interpretation Our data suggest that seroconversion after a first COVID-19 vaccination is delayed in older patients on specific immunosuppressive drugs, but that second or repeated exposure to SARS-CoV-2, either via infection or vaccination, improves humoral immunity in patients treated with immunosuppressive drugs. Therefore, delayed second dosing of COVID-19 vaccines should be avoided in patients receiving immunosuppressive drugs. Future studies that include younger patients need to be done to confirm the generalisability of our results. Funding ZonMw, Reade Foundation, and MS Center Amsterdam.
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Affiliation(s)
- Laura Boekel
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
| | | | - Femke Hooijberg
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
| | - Yaëlle R Besten
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
| | | | - Laura Y Kummer
- Department of Immunopathology, Amsterdam, Netherlands
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, University of Amsterdam, Amsterdam, Netherlands
| | | | - Sofie Keijzer
- Department of Immunopathology, Amsterdam, Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | | | - Maarten Boers
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Amsterdam, Netherlands
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
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