IMMUNOGENICITY AND SAFETY OF THE BNT162b2 mRNA COVID-19 VACCINE IN ADULT PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES AND GENERAL POPULATION: A MULTICENTER STUDY
Authors: V. Furer et al.
This is a prospective study Israel has vaccinated early on a large proportion of its population with the Pfizer–BioNTech mRNA vaccine. The authors of this report prospectively investigated the efficacy and safety of the COVID-19 mRNA vaccine in patients with inflammatory RMDs and compared it to the general population. A total 686 patients with autoimmune diseases were enrolled.
Overall the seropositivity rate was 86% (n=590) in patients with inflammatory RMDs compared to 100% in controls (p <0.0001), and the level of the anti-COVID-19 antibodies was significantly reduced compared to controls (mean 133 vs 219, p<0.0001). Older age, a diagnosis of RA, ANCA-associated vasculitis, or inflammatory myositis was associated with a lower vaccination response to the COVID-19 vaccination. Certain therapies further decreased the effectiveness of vaccination: Rituximab, glucocorticoids, mycophenolate mofetil, and abatacept significantly impaired the vaccination response. Methotrexate also reduced the seroconversion, but to a lesser degree.
It has been known for a long time that active and passive smoking is a risk factor for developing RA. Once RA has deCOVID-19 vaccination raises questions, in particular for patients with inflammatory RMDs, because of fears the COVID-19 vaccination was reasonably effective in a majority of patients with inflammatory RMDs, but it is important to be reminded that one out of seven to one out of 5 of our patients may still not respond to two COVID-19 vaccinations. In particular, treatment with rituximab, glucocorticoids, mycophenolate mofetil, abatacept and methotrexate may impair the COVID-19 vaccination immunogenicity. In accordance with recent management guidelines from ACR, it seems reasonable to hold some of these therapies during a short period prior to- and shortly after the COVID-19 vaccination, and to postpone rituximab until the vaccination is finalized.