Immune Response to SARS-CoV-2 Third Vaccine in Patients With Rheumatoid Arthritis Who Had No Seroconversion After Primary 2-Dose Regimen With Inactivated or Vector-Based Vaccines

• Published in: Journal of rheumatology 2022-12, Vol.49 (12), p.1385-1389
• Main Authors: Isnardi, Carolina A, Cerda, Osvaldo L, Landi, Margarita, Cruces, Leonel, Schneeberger, Emilce E, Montoro, Claudia Calle, Alfaro, María Agustina, Roldán, Brian M, Gómez Vara, Andrea B, Giorgis, Pamela, Ezquer, Roberto Alejandro, Crespo Rocha, María G, Reyes Gómez, Camila R, de Los Ángeles Correa, Mária, Rosemffet, Marcos G, Abarza, Virginia Carrizo, Pellet, Santiago Catalan, Perandones, Miguel, Reimundes, Cecilia, Longueira, Yesica, Turk, Gabriela, Quiroga, María Florencia, Laufer, Natalia, Quintana, Rosana, de la Vega, María Celina, Kreplak, Nicolás, Pifano, Marina, Maid, Pablo, Pons-Estel, Guillermo J, Citera, Gustavo
• Format: Article
• Language: English
• Subjects: Abatacept; Antibodies, Viral; Arthritis, Rheumatoid - drug therapy; BNT162 Vaccine; ChAdOx1 nCoV-19; COVID-19 - prevention & control; COVID-19 Vaccines; Humans; Immunity; Immunoglobulin G; Rituximab; SARS-CoV-2; Vaccination; Vaccines
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.220469

The aim of this study was to assess the immune response after a third dose of SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA) with undetectable antibody titers after the primary regimen of 2 doses. Patients with RA with no seroconversion after 2 doses of SARS-CoV-2 vaccine and who received a third dose of either an mRNA or vector-based vaccine were included. Anti-SARS-CoV-2 IgG antibodies, neutralizing activity, and T cell responses were assessed after the third dose. A total of 21 nonresponder patients were included. At the time of vaccination, 29% were receiving glucocorticoids and 85% biologic disease-modifying antirheumatic drugs (including 6 taking abatacept [ABA] and 4 taking rituximab [RTX]). The majority (95%) received the BNT162b2 vaccine and only one of them received the ChAdOx1 nCoV-19 vaccine. After the third dose, 91% of the patients presented detectable anti-SARS-CoV-2 IgG and 76% showed neutralizing activity. Compared to other treatments, ABA and RTX were associated with the absence of neutralizing activity in 4 out of 5 (80%) patients and lower titers of neutralizing antibodies (median 3, IQR 0-20 vs 8, IQR 4-128; = 0.20). Specific T cell response was detected in 41% of all patients after the second dose, increasing to 71% after the third dose. The use of ABA was associated with a lower frequency of T cell response (33% vs 87%, = 0.03). In this RA cohort, 91% of patients who failed to seroconvert after 2 doses of SARS-CoV-2 vaccine presented detectable anti-SARS-CoV-2 IgG after a third dose. The use of ABA was associated with a lower frequency of specific T cell response.