SARS-CoV-2 Vaccine-Induced Antibody Responses in Patients Treated With Glucocorticoids or B-Cell Depletion Therapy

Researchers conducted a study to assess the immunogenicity of mRNA-based SARS-CoV-2 vaccines among patients with chronic inflammatory disease vs those with immunocompetence.

SARS-CoV-2 vaccine-induced antibody responses were observed to be decreased among patients with chronic inflammatory disease (CID) who were receiving B-cell depletion therapy (BCDT) or glucocorticoids. These findings, from a prospective cohort study, were published in the Annals of Internal Medicine.

The COVID-19 Vaccine Responses in Patients with Autoimmune Disease (COVaRiPAD) study was conducted at Washington University School of Medicine and University of California San Francisco between December 2020 and March 2021. Healthcare workers of any age or clinic patients older than 65 years of age who had either CID (n=133) or were immunocompetent (n=53) were assessed for humoral responses within 2 weeks prior to receiving their first vaccine dose and 20 days after final vaccine dose.

Patients in the CID and immunocompetent cohorts comprised 74.4% and 54.7% women, mean ages were 45.5 ± 16.0 and 43.4 ± 14.1 years, 88.0% and 79.2% were White, and mean BMIs were 26.6 ± 6.3 and 27.9 ± 7.6 kg/m2, respectively. For patients in the CID group, the most common diagnoses were inflammatory bowel disease (31.6%) and rheumatoid arthritis (28.6%), and common treatments were tumor necrosis factor inhibitors (28.6%) and methotrexate (21.8%).

After vaccination, seroconversion occurred among 88.7% of patients in the CID and 100.0% of those in the immunocompetent cohorts. The geometric mean at half-maximal dilution and half-maximal neutralization were both decreased among patients in the CID group vs the immunocompetent group (1737 vs 5542 and 2312 vs 6261, respectively). In addition, circulating plasmablasts were increased among patients in the immunocompetent group compared with those in the CID group (48 vs 179 spot-forming units per 106 peripheral blood mononuclear cells [PBMCs], respectively).

After stratification by glucocorticoid use, the geometric mean of anti-S immunoglobulin (Ig) G antibodies was decreased among prednisone users (n=17) compared with non-users (357 vs 2190), with similar results observed in regard to the geometric mean at half-maximal neutralization (767 vs 2509) and circulating plasmablasts (5 vs 58 spot-forming units per 106 PBMCs), respectively. Overall, only 65% of patients using prednisone were seropositive compared with 92% of non-users.

Among the 10 patients who used BCDT, the researchers noted a 60% decreased immunogenicity compared with non-users with a decreased geometric mean of anti-S IgG antibodies (152 vs 2117) and decreased half-maximal neutralization titer (723 vs 2445).

No significant effect on immunogenicity responses were observed among patients who were treated with antimetabolites, tumor necrosis factor inhibitors, or Janus kinase inhibitors.

The study was limited because the findings were based on few patients who were mostly White women. Larger, more diverse studies are needed to confirm these results.

These data indicated that patients with CID who are treated with BCDT or glucocorticoids likely have decreased SARS-CoV-2 vaccine-induced antibody responses.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Deepak P, Kim W, Paley MA, et al. Effect of immunosuppression on the immunogenicity of mRNA vaccines to SARS-CoV-2: a prospective cohort study. Ann Intern Med. 2021;M21-1757. doi:10.7326/M21-1757