Effectiveness of SARS-CoV-2 vaccination in patients with rheumatoid arthritis (RA) on DMARDs: as determined by antibody and T cell responses

• Published in: Rheumatic & musculoskeletal diseases open 2022-03, Vol.8 (1), p.e002050
• Main Authors: Saleem, Benazir, Ross, Rebecca L, Bissell, Lesley-Anne, Aslam, Aamir, Mankia, Kulveer, Duquenne, Laurence, Corsadden, Diane, Carter, Clive, Hughes, Pam, Nadat, Fatima A, Mulipa, Panji, Lobb, Mark, Clarke, Brendan, Mbara, Katie, Morton, Ruth, Dibb, Sophie, Chowdhury, Rahaymin, Newton, Darren, Pike, Alexandra, Kakkar, Vishal, Savic, Sinisia, DelGaldo, Francesco, Emery, Paul
• Format: Article
• Language: English
• Subjects: Antibodies; Antigens; antirheumatic agents; Antirheumatic Agents - therapeutic use; arthritis, rheumatoid; Arthritis, Rheumatoid - drug therapy; Coronaviruses; COVID-19; COVID-19 - prevention & control; COVID-19 Vaccines; Cytokines; Disease; Drug dosages; Humans; Infections; Lymphocytes; Prospective Studies; Rheumatoid Arthritis; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Steroids; T-Lymphocytes; Tumor necrosis factor-TNF; Vaccination; Variance analysis
• ISSN: 2056-5933; 2056-5933
• DOI: 10.1136/rmdopen-2021-002050

ObjectivesTo assess antibody and T cell responses to SARS-CoV-2 vaccination in patients with rheumatoid arthritis (RA) on disease-modifying antirheumatic drugs (DMARDs).MethodsThis prospective study recruited 100 patients with RA on a variety of DMARDs for antibody and T cell analysis, pre-vaccination and 4 weeks post-vaccination. Positive antibody response was defined as sera IgG binding to ≥1 antigen. Those that remained seronegative after first vaccination were retested 4 weeks after second vaccination; and if still seronegative after vaccination three. A T cell response was defined an ELISpot count of ≥7 interferon (IFN)γ-positive cells when exposed to spike antigens. Type I IFN activity was determined using the luminex multiplex assay IFN score.ResultsAfter vaccine one, in patients without prior SARS-CoV-2 exposure, 37/83 (45%) developed vaccine-specific antibody responses, 44/83 (53%) vaccine-specific T cell responses and 64/83 (77%) developed either antibody or T cell responses. Reduced seroconversion was seen with abatacept, rituximab (RTX) and those on concomitant methotrexate (MTX) compared to 100% for healthy controls (p