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Antibody Development after SARS-CoV-2 Vaccinations in Elderly Patients with Autoimmune Diseases: Data From a Prospective Controlled Cohort Study

20 Pages Posted: 28 Jun 2021

See all articles by Laura Boekel

Laura Boekel

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade

Maurice Steenhuis

Sanquin Research - Department of Immunopathology

Femke Hooijberg

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade

Yaëlle Besten

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade

Zoé van Kempen

Amsterdam UMC, Vrije Universiteit - Department of Neurology

Laura Kummer

Amsterdam UMC - Department of Neurology and Neurophysiology

P.J. van Dam

Amsterdam UMC - Department of Neurology and Neurophysiology

Eileen Stalman

Amsterdam UMC - Department of Neurology and Neurophysiology

Erik Vogelzang

University of Amsterdam - Department of Medical Microbiology and Infection Control

Olfi Christianawati

Sanquin Research - Department of Immunopathology

Sofie Keijzer

Sanquin Research - Department of Immunopathology

Gestur Vidarsson

Sanquin Research - Department of Immunopathology

Alexandre Voskuyl

VU University Medical Center - Amsterdam Rheumatology and Immunology Center

Luuk Wieske

Amsterdam UMC - Department of Neurology and Neurophysiology

Filip Eftimov

Amsterdam UMC - Department of Neurology and Neurophysiology

Ronald van Vollenhoven

University of Amsterdam - Department of Rheumatology and Clinical Immunology

Taco Kuijpers

University of Amsterdam - Department of Pediatric Immunology, Rheumatology and Infectious Disease

Marieke van Ham

Sanquin Research - Department of Immunopathology

Sander Tas

University of Amsterdam - Department of Rheumatology and Clinical Immunology

Joep Killestein

VU University Amsterdam; Amsterdam UMC, Vrije Universiteit - Department of Neurology

Maarten Boers

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre

Michael Nurmohamed

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre

Theo Rispens

Sanquin Research - Department of Immunopathology

Gertjan Wolbink

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade

More...

Abstract

Introduction: Data on immunogenicity of SARS-CoV-2 vaccines in patients with autoimmune diseases are still scarce, because these patients were largely excluded from SARS-CoV-2 vaccine trials. 

Methods: Serum samples of patients with autoimmune diseases (n = 480) and healthy controls (n = 204) included in two ongoing prospective cohort studies were collected after first or second SARS-CoV-2 vaccinations. Seroconversion rates and IgG antibody titers against the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein were measured. Multivariable logistic and linear regression analyses were used to investigate associations between medication, seroconversion rates and IgG antibody titers respectively.

Findings: Seroconversion rates after a first SARS-CoV-2 vaccination in 111 patients on methotrexate (25%, adjusted OR: 0.1, 95% CI: 0.1 – 0.2, P < 0.001) and 15 patients on anti-CD20 therapies (0%, P < 0.001) were lower compared to 103 healthy controls (71%). For patients on tumor necrosis factor (TNF) inhibitors (adjusted OR: 0.7, 95% CI: 0.4 – 1.4, P = 0.20) and patients on prednisone monotherapy (adjusted OR: 0.6, 95% CI: 0.2 – 1.5, P = 0.25) seroconversion rates were similar compared to controls. After the second SARS-CoV-2 vaccination seroconversion rates exceeded 88% in all patient subgroups, except in patients treated with anti-CD20 therapies (2 (33%) of 6). Seroconversion rates and IgG antibody titers were similar for patients with a prior SARS-CoV-2 infection who had received a single vaccine dose and patients without a prior SARS-CoV-2 who had received two vaccine doses. 

Interpretation: Treatment regimens other than anti-CD20 therapies of patients with autoimmune diseases do not need to be postponed when these patients receive a SARS-CoV-2 vaccination. Patients receiving anti-CD20 therapies may benefit from a second booster vaccination, as our data suggest that repeated exposure to SARS-CoV-2 vaccines or the virus itself enhances the development of humoral immunity in these patients.

Funding: ZonMw, Reade Foundation and MS Center Amsterdam.

Declaration of Interest: None to declare.

Ethical Approval: The research protocols were approved by the medical ethical committee of the VU University medical center (registration number 2020.169 and 2020.370). All participants gave informed consent.

Suggested Citation

Boekel, Laura and Steenhuis, Maurice and Hooijberg, Femke and Besten, Yaëlle and van Kempen, Zoé and Kummer, Laura and van Dam, Koos and Stalman, Eileen and Vogelzang, Erik and Christianawati, Olfi and Keijzer, Sofie and Vidarsson, Gestur and Voskuyl, Alexandre and Wieske, Luuk and Eftimov, Filip and van Vollenhoven, Ronald and Kuijpers, Taco and van Ham, Marieke and Tas, Sander and Killestein, Joep and Boers, Maarten and Nurmohamed, Michael and Rispens, Theo and Wolbink, Gertjan, Antibody Development after SARS-CoV-2 Vaccinations in Elderly Patients with Autoimmune Diseases: Data From a Prospective Controlled Cohort Study. Available at SSRN: https://ssrn.com/abstract=3869656 or http://dx.doi.org/10.2139/ssrn.3869656

Laura Boekel (Contact Author)

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade ( email )

Amsterdam
Netherlands

Maurice Steenhuis

Sanquin Research - Department of Immunopathology

Amsterdam
Netherlands

Femke Hooijberg

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade ( email )

Amsterdam
Netherlands

Yaëlle Besten

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade ( email )

Amsterdam
Netherlands

Zoé Van Kempen

Amsterdam UMC, Vrije Universiteit - Department of Neurology ( email )

Spui 21
Amsterdam, 1018 WB
Netherlands

Laura Kummer

Amsterdam UMC - Department of Neurology and Neurophysiology ( email )

Netherlands

Koos Van Dam

Amsterdam UMC - Department of Neurology and Neurophysiology ( email )

Meibergdreef 9
Amsterdam, Noord Holland 1105
Netherlands

Eileen Stalman

Amsterdam UMC - Department of Neurology and Neurophysiology ( email )

Netherlands

Erik Vogelzang

University of Amsterdam - Department of Medical Microbiology and Infection Control ( email )

Amsterdam
Netherlands

Olfi Christianawati

Sanquin Research - Department of Immunopathology ( email )

Amsterdam
Netherlands

Sofie Keijzer

Sanquin Research - Department of Immunopathology

Amsterdam
Netherlands

Gestur Vidarsson

Sanquin Research - Department of Immunopathology

Alexandre Voskuyl

VU University Medical Center - Amsterdam Rheumatology and Immunology Center ( email )

Luuk Wieske

Amsterdam UMC - Department of Neurology and Neurophysiology ( email )

Spui 21
Amsterdam, 1018 WB
Netherlands

Filip Eftimov

Amsterdam UMC - Department of Neurology and Neurophysiology ( email )

Spui 21
Amsterdam, 1018 WB
Netherlands

Ronald Van Vollenhoven

University of Amsterdam - Department of Rheumatology and Clinical Immunology ( email )

Amsterdam
Netherlands

Taco Kuijpers

University of Amsterdam - Department of Pediatric Immunology, Rheumatology and Infectious Disease ( email )

Marieke Van Ham

Sanquin Research - Department of Immunopathology

Amsterdam
Netherlands

Sander Tas

University of Amsterdam - Department of Rheumatology and Clinical Immunology ( email )

Amsterdam
Netherlands

Joep Killestein

VU University Amsterdam ( email )

Amsterdam UMC, Vrije Universiteit - Department of Neurology ( email )

Meibergdreef 9
Amsterdam, Noord Holland 1105
Netherlands

Maarten Boers

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre

Amsterdam
Netherlands

Michael Nurmohamed

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre ( email )

Amsterdam
Netherlands

Theo Rispens

Sanquin Research - Department of Immunopathology

Amsterdam
Netherlands

Gertjan Wolbink

University of Amsterdam - Amsterdam Rheumatology and Immunology Centre, Location Reade ( email )

Amsterdam
Netherlands