Vaccine Efficacy in SLE Patients Across Multiple Variants

July 15, 2022

A study published earlier this week investigated vaccine immune responses in SLE patients. This is one of the first studies on vaccine efficacy of a primary series and booster dose across multiple variants, including the BA.1 omicron variant, especially in an autoimmune disease patient cohort.

Vaccine responses from 163 patients vaccinated between December 2021 and February 2022 were evaluated for clinical efficacy and seroreactivity. Patients were members of the New York University Lupus Cohort, and received a two-dose primary series of an mRNA vaccine, or one dose primary series of the Johnson & Johnson COVID-19 vaccine. 125 of 163 patients received an additional dose.

“At the time of initial vaccination, 82 (50%) of 163 patients were on at least one immunosuppressant and 26 (16%) were on more than one immunosuppressant.” Of 125 patients who received a booster dose, 28 experienced a breakthrough infection. 16 patients who did not receive a booster experienced a breakthrough infection. 13 of 43 patients taking the immunosuppressant mycophenolate mofetil at the time of their primary series and 2 of 4 patients taking rituximab in the six months prior to vaccination experienced a breakthrough infection. “There was no association between antibody titre after the additional dose and breakthrough SARS-CoV-2 infection.”

Overall, patients with SLE showed favorable serological responses after a booster dose compared to a primary series. That being said, “SARS-CoV-2 spike antibody titre was not associated with breakthrough SARS-CoV-2 infection, potentially indicating the known immune evasion of the omicron variant or a plateau effect beyond a particular antibody titre.” Authors suggest that mild cases of COVID-19 amongst the cohort point to the the power of T-cell immunity, which is constant across the alpha strain and omicron variants.

It is important to note that one limitation of the study was the incidence of self-reported COVID-19 infection in many cases.