Effect of Systemic Lupus Erythematosus and Immunosuppressive Agents on COVID-19 Vaccination Antibody Response.
Humans
Antibodies, Viral
/ therapeutic use
Antibody Formation
COVID-19
/ prevention & control
COVID-19 Vaccines
/ administration & dosage
Immunoglobulin G
/ therapeutic use
Immunosuppressive Agents
/ adverse effects
Lupus Erythematosus, Systemic
/ drug therapy
SARS-CoV-2
Tacrolimus
/ therapeutic use
Vaccination
Journal
Arthritis care & research
ISSN: 2151-4658
Titre abrégé: Arthritis Care Res (Hoboken)
Pays: United States
ID NLM: 101518086
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
03
01
2023
received:
05
09
2022
accepted:
26
01
2023
pmc-release:
01
09
2024
medline:
31
8
2023
pubmed:
31
1
2023
entrez:
30
1
2023
Statut:
ppublish
Résumé
The risk of COVID-19 infection is increased in patients with systemic lupus erythematosus (SLE) versus those without SLE. Some immunosuppressive medications increase COVID-19 infection and decrease the efficacy of vaccination. Consensus documents have suggested management strategies for handling immunosuppressive medications to increase vaccine efficacy, but the benefit of such strategies has not been proven. The current study was undertaken to determine the effect of immunosuppressive drugs on vaccine response in SLE. We collected information on COVID-19 infection, vaccination history, and COVID-19 antibodies in the Hopkins Lupus Cohort. A cohort of health care workers was used for comparison. Outcome measures included SARS-CoV-2 antibody IgG levels after vaccination over time in both cohorts and effect of immunosuppressive medications on postvaccination IgG levels in SLE patients. The analysis was based on 365 observations from 334 different patients in the SLE cohort, and 2,235 observations from 1,887 different health care workers. SLE patients taking immunosuppressive medications had lower vaccine IgG levels than SLE patients who were not; but both groups had lower levels than health care workers. Holding mycophenolate for 1 week after vaccination increased postvaccine IgG levels significantly without leading to clinical flares. In multiple variable models, mycophenolate mofetil, tacrolimus, and belimumab all significantly reduced antibody response to vaccination. SLE patients, regardless of background immunosuppressive therapy, had lower vaccine IgG levels than health care workers. Mycophenolate, tacrolimus, and belimumab significantly reduced IgG response to vaccination. Holding mycophenolate for 1 week improved vaccine efficacy, providing clinical benefit on vaccine response without leading to clinical flares.
Identifiants
pubmed: 36714913
doi: 10.1002/acr.25094
pmc: PMC10387122
mid: NIHMS1869558
doi:
Substances chimiques
Antibodies, Viral
0
COVID-19 Vaccines
0
Immunoglobulin G
0
Immunosuppressive Agents
0
Tacrolimus
WM0HAQ4WNM
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1878-1885Subventions
Organisme : NIAID NIH HHS
ID : T32 AI007291
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR069572
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI141580
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.
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