Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune mediated inflammatory diseases

  1. Roya M. Dayam
  2. Jaclyn C. Law
  3. Rogier L. Goetgebuer
  4. Gary Y. C. Chao
  5. Kento T. Abe
  6. Mitchell Sutton
  7. Naomi Finkelstein
  8. Joanne M. Stempak
  9. Daniel Pereira
  10. David Croitoru
  11. Lily Acheampong
  12. Saima Rizwan
  13. Klaudia Rymaszewski
  14. Raquel Milgrom
  15. Darshini Ganatra
  16. Nathalia V. Batista
  17. Melanie Girard
  18. Irene Lau
  19. Ryan Law
  20. Michelle W. Cheung
  21. Bhavisha Rathod
  22. Julia Kitaygorodsky
  23. Reuben Samson
  24. Queenie Hu
  25. W. Rod Hardy
  26. Nigil Haroon
  27. Robert D. Inman
  28. Vincent Piguet
  29. Vinod Chandran
  30. Mark S. Silverberg
  31. Anne-Claude Gingras
  32. Tania H. Watts
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Abstract

Background

Limited information is available on the impact of immunosuppressants on COVID-19 vaccination in patients with immune-mediated inflammatory diseases (IMID).

Methods

This observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, or psoriatic disease, with or without maintenance immunosuppressive therapies. Antibody and T cell responses to SARS-COV-2, including neutralization against SARS-CoV-2 variants were determined before and after 1 and 2 vaccine doses.

Results

We prospectively followed 150 subjects, 26 healthy controls, 9 IMID patients on no treatment, 44 on anti-TNF, 16 on anti-TNF with methotrexate/azathioprine (MTX/AZA), 10 on anti-IL-23, 28 on anti-IL-12/23, 9 on anti-IL-17, and 8 on MTX/AZA. Antibody and T cell responses to SARS-CoV-2 were detected in all participants, increasing from dose 1 to dose 2 and declining 3 months later, with greater attrition in IMID patients compared to healthy controls. Antibody levels and neutralization efficacy against variants of concern were substantially lower in anti-TNF treated patients than in healthy controls and were undetectable against Omicron by 3 months after dose 2.

Conclusions

Our findings support the need for a third dose of mRNA vaccine and for continued monitoring of immunity in these patient groups.

Funding

Funded by a donation from Juan and Stefania Speck and by Canadian Institutes of Health (CIHR) /COVID-Immunity Task Force (CITF) grants VR-1 172711 and VS1-175545 (T.H.W. and A.C.G); CIHR FDN-143250 (T.H.W.), GA2-177716 (V.C., A.C.G., T.W.), GA1-177703 (A.C.G.) and the CIHR rapid response network to SARS-CoV-2 variants, CoVaRR-Net (to A.C.G.).

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