Antibody Development Following COVID Vaccine in Autoimmune Disease Patients

August 10, 2021

A study coming from the Netherlands looks at the immune response following COVID-19 vaccination in patients with autoimmune disease, focusing specifically on the effects of different immunosuppressive drugs on antibody development. Researchers used serum samples from 289 patients without autoimmune disease, who served as the control group, and 632 patients with autoimmune disease (including rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematous, and multiple sclerosis). The mean age of participants was 63 years and 57% of participants were female.

Serum samples were collected from participants after their first or second dose of the COVID-19 vaccine (to include Johnson & Johnson, Pfizer, AstraZeneca, and Moderna). “Among participants without previous SARS-CoV-2 infection, seroconversion after first vaccination were significantly lower in patients than in [the] control,” mainly due to the use of immunosuppressive therapies in autoimmune disease patients (namely, methotrexate or anti-CD20 therapies versus prednisone or TNF inhibitors). Seroconversion is the transition from viral infection to antibody presence in the body.

After the second dose, seroconversion surpassed 80% in all patients regardless of treatment, except those treated with anti-CD20 therapies. In this treatment subgroup, 3 of 7 patients exceeded 80% seroconversion. Seroconversion rates and antibody titers were similar across autoimmune disease types and vaccine types included in the study, “suggesting that treatment with immunosuppressive medication, rather than the underlying autoimmune disease, is the main factor that influences immunogenicity of vaccines.”

Researchers did not observe a difference in seroconversion and IgG antibody titers between patients with a previous COVID-19 infection who received one dose of the vaccine and patients without a previous COVID-19 infection who received both doses. Researchers also stated that a second or repeated exposure to SARS-CoV-2 via infection improves immunity in patients on immunosuppressive therapies. This is an interesting remark as studies and clinical data suggest the autoimmune disease population is at increased risk of developing severe disease from a COVID-19 infection (1, 2, 3). That being said, “delayed second dosing of COVID-19 vaccines should be avoided in patients receiving immunosuppressive drugs.”

While the results of this study are informative and provide clarity for the autoimmune disease population, further studies should be conducted with younger patients. Additionally, the study did not measure the timing of anti-CD20 therapy prior to vaccination.