Effect of Immunosuppression on the Immunogenicity of mRNA Vaccines to SARS-CoV-2
Parakkal Deepak, Wooseob Kim, Michael Paley, Monica Yang, Alexander Carvidi, Emanuel Demissie, Alia A. El‐Qunni, Alem Haile, Katherine Huang, Baylee Kinnett, Mariel J. Liebeskind, Zhuoming Liu, Lily E. McMorrow, Diana Paez, Niti Pawar, Dana C. Perantie, Rebecca E. Schriefer, Shannon E. Sides, Mahima Thapa, M Gergely, Suha Abushamma, Sewuese Akuse, Michael K. Klebert, Lynne M. Mitchell, Darren Nix, Jonathan Graf, Kimberly E. Taylor, Salim Chahin, Matthew A. Ciorba, Patricia Katz, Mehrdad Matloubian, Jane A. O’Halloran, Rachel M. Presti, Gregory F. Wu, Sean P. J. Whelan, William Buchser, Lianne S. Gensler, Mary C. Nakamura, Ali H. Ellebedy, Alfred H.J. Kim
Abstract
BACKGROUND: Patients with chronic inflammatory disease (CID) treated with immunosuppressive medications have increased risk for severe COVID-19. Although mRNA-based SARS-CoV-2 vaccination provides protection in immunocompetent persons, immunogenicity in immunosuppressed patients with CID is unclear. OBJECTIVE: To determine the immunogenicity of mRNA-based SARS-CoV-2 vaccines in patients with CID. DESIGN: Prospective observational cohort study. SETTING: Two U.S. CID referral centers. PARTICIPANTS: Volunteer sample of adults with confirmed CID eligible for early COVID-19 vaccination, including hospital employees of any age and patients older than 65 years. Immunocompetent participants were recruited separately from hospital employees. All participants received 2 doses of mRNA vaccine against SARS-CoV-2 between 10 December 2020 and 20 March 2021. Participants were assessed within 2 weeks before vaccination and 20 days after final vaccination. MEASUREMENTS: binding in all participants, and neutralizing antibody titers and circulating S-specific plasmablasts in a subset to assess humoral response after vaccination. RESULTS: = 11); however, 95% CIs were wide and overlapped. Neutralization titers seemed generally consistent with anti-S IgG results. Results were not adjusted for differences in baseline clinical factors, including other immunosuppressant therapies. LIMITATIONS: Small sample that lacked demographic diversity, and residual confounding. CONCLUSION: Compared with nonusers, patients with CID treated with glucocorticoids and BCDT seem to have lower SARS-CoV-2 vaccine-induced antibody responses. These preliminary findings require confirmation in a larger study. PRIMARY FUNDING SOURCE: The Leona M. and Harry B. Helmsley Charitable Trust, Marcus Program in Precision Medicine Innovation, National Center for Advancing Translational Sciences, and National Institute of Arthritis and Musculoskeletal and Skin Diseases.