Waning humoral and cellular immunity after COVID-19 vaccination in patients with psoriasis treated with methotrexate and biologics: a cohort study

• Published in: British journal of dermatology (1951) 2023-04, Vol.188 (5), p.661-669
• Main Authors: Kvist-Hansen, Amanda, Pérez-Alós, Laura, Al-Sofi, Rownaq Fares, Heftdal, Line Dam, Hamm, Sebastian Rask, Møller, Dina Leth, Pries-Heje, Mia Marie, Fogh, Kamille, Hansen, Cecilie Bo, Hasselbalch, Rasmus Bo, Madsen, Johannes Roth, Armenteros, Jose Juan Almagro, Frikke-Schmidt, Ruth, Hilsted, Linda, Sørensen, Erik, Ostrowski, Sisse Rye, Bundgaard, Henning, Nielsen, Susanne Dam, Iversen, Kasper, Zachariae, Claus, Garred, Peter, Skov, Lone
• Format: Article
• Language: English
• Subjects: Antibodies, Viral; Biological Products - therapeutic use; Cohort Studies; COVID-19 - prevention & control; COVID-19 Vaccines; Humans; Immunity, Cellular; Methotrexate - therapeutic use; Prospective Studies; Psoriasis - drug therapy; SARS-CoV-2; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha; Vaccination
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1093/bjd/ljad023

mRNA-based COVID-19 vaccines have short- and long-term efficacy in healthy individuals, but their efficacy in patients with psoriasis receiving immunomodulatory therapy is less studied. To investigate long-term immunity after COVID-19 vaccination in patients with psoriasis receiving immunomodulatory therapy. A prospective cohort study including patients (n = 123) with psoriasis receiving methotrexate (MTX) or biologics and controls (n = 226). Only mRNA-based COVID-19 vaccines administered with standard intervals between doses were investigated. Markers of immunity included SARS-CoV-2 spike glycoprotein-specific IgG and IgA, neutralizing capacity, and interferon-γ release from T cells stimulated with peptides of the SARS-CoV-2 spike glycoprotein. The proportion of IgG responders was lower 6 months after vaccination in patients receiving anti-tumour necrosis factor (TNF) treatment compared with controls. Anti-TNF treatment was associated with lower IgG levels (β = -0.82, 95% confidence interval -1.38 to -0.25; P = 0.001). The median neutralizing index was lower in the anti-TNF group [50% inhibition (interquartile range [IQR] 37-89)] compared with controls [98% inhibition (IQR 96-99)]; P < 0.001. Cellular responses were numerically lowest in the anti-TNF group. Treatment with anti-TNF has an impact on the immunity elicited by mRNA-based COVID-19 vaccination in patients with psoriasis, resulting in a faster waning of humoral and cellular markers of immunity; however, the clinical implications are unknown.