After vaccination against SARS-CoV-2 infection, patients with immune-mediated inflammatory diseases (IMID) have decreased seroconversion rates, which may be impacted by certain immune-modulating medications, according to results of a systematic review published in Autoimmunity Reviews.
Investigators searched electronic databases to identify studies that reported SARS-Cov-2 seroconversion rates following SARS-CoV-2 mRNA vaccination in patients with IMIDs, as well as studies that compared seroconversion rates between those with IMIDs and healthy controls, and studies that reported seroconversion rates based on specific immune-modulating therapies in those with IMID. They calculated the pooled seroconversion rates among patients, including, those who received 1 vs 2 COVID-19 vaccine doses, those with specific IMIDs, those who underwent treatment with various medications, and the pooled odds for response of vaccine among those with IMIDs compared with healthy controls. There were 25 studies included in the systematic review.
The pooled seroconversion rate was increased after 2 vaccine doses (83.1; 95% CI, 74.9-89.0; I2=90%) compared with 1 dose (69.3; 95% CI, 52.4-82.3; I2=95%). The odds of seroconversion were significantly decreased in patients with IMIDs compared with healthy controls (0.05; 95% CI, 0.02-0.13; I2=21%). Among patients with IMIDs, seroconversion rates were increased in those with inflammatory bowel disease, spondyloarthropathy, and systemic lupus erythematosus compared with those with rheumatoid arthritis and vasculitis.
Seroconversion rates following 2 doses of mRNA vaccination showed significant improvement (>90%) in patients treated with anti-tumor necrosis factor (TNF), anti-integrin (vedolizumab), anti-IL-17 (secukinumab), anti-IL-6 (tocilizumab), and anti-IL-12/23 (ustekinumab) therapies. Seroconversion rates showed moderate improvement (70% to 90%) in patients treated with steroids, hydroxychloroquine, janus kinase inhibitors, mycophenolate mofetil, and leflunomide.
Seroconversion rates were attenuated (<70%) in patients treated with anti-CD20 (rituximab), and anti-cytotoxic T-lymphocyte-associated antigen (abatacept) therapies. Anti-TNF therapy in combination with immune-modulators (azathioprine, 6-mercaptopurine, methotrexate) yielded an attenuated vaccine response compared with that in patients treated with anti-TNF therapy alone.
The study was limited by the heterogeneity of individual therapies, combination therapies, vaccine type, number of doses, and the definition and time of measurement of seroconversion across studies. Because data are sparse regarding T-cell responses to SARS-CoV-2 infection in patients with IMIDs, the investigators were not able to fully address breakthrough SARS-CoV-2 infection in this population.
“The present systematic review highlights the importance of a -dose mRNA vaccine regimen in patients with IMIDs;” and, “due to vaccine shortage, some governments have increased the interval between the first and second dose of the vaccine. Our data suggests that this approach may not be appropriate for patients with underlying IMIDs,” the investigators concluded.
Jena A, Mishra S, Deepak P, et al. Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: Systematic review and meta-analysis. Autoimmun Rev. Published online August 30, 2021. doi:10.1016/j.autrev.2021.102927