COVID-19 Boosters in Autoimmune Rheumatic and Musculoskeletal Patients

February 1, 2023

Even though COVID-19 vaccination is recommended for patients with autoimmune rheumatic and musculoskeletal diseases (aiRMDs), clinical research is scarce on how a booster dose or infection following a two-dose primary series influences the immune system.

Researchers in Hungary analyzed the immune response in aiRMDs patients after receiving a COVID-19 booster, as well as those who experienced a SARS-CoV-2 infection after receiving two doses of a COVID-19 vaccine. The cohort consisted of 46 patients with aiRMDs who received two doses of either Sinopharm, Sputnik V, AstraZeneca, or Pfizer, followed by a Pfizer COVID-19 booster dose or who experienced a SARS-CoV-2 infection six months after their second vaccine dose. Researchers compared the immune responses in patients who received three vaccines from the same manufacturer, a primary series from one manufacturer with a mix-and-match booster, and a third group who was infected with SARS-CoV-2 following immunization with two vaccine doses. 

Participants’ underlying diseases were in remission or had low activity. Additionally, all participants were on stable medication for at least eight weeks prior to enrollment; patients were advised to discontinue medication for two weeks during their vaccination or infection period. 

Researchers analyzed the immune system of study participants four months after booster shots or SARS-CoV-2 infection. While levels of specific antibodies differed, generally, a booster dose or infection helped to increase the levels of antibodies in patients, thus increasing protection against the virus. This data aligns with findings from other studies showing that vaccination and boosters reduced hospitalizations and deaths among aiRMDs patients. Boosters were similarly effective regardless of whether the booster was from the same manufacturer as the primary series, mix-and-matched, or if a SARS-CoV-2 infection was serving as a booster. 

Importantly, boosters were not observed to increase the clinical activity of aiRMDs. Researchers did not observe any significant flares or relapses among patients following a booster dose or infection. Patients infected with SARS-CoV-2 following the two-dose vaccination suffered only mild symptoms, and none of the aiRMDs patients in the study were hospitalized or died.