Full Papers
Immunogenicity and risk of disease flare after a three-dose regimen with SARS-CoV-2 vaccination in patients with systemic lupus erythematosus: results from the prospective cohort study COVAC-SLE
E.S. Larsen1, A.C. Nilsson2, S. Möller3, A.B. Voss4, I.S. Johansen5
- Department of Rheumatology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark; and Department of Clinical Immunology, Odense University Hospital, Odense, Denmark. emilie.stavnsbjerg.larsen2@rsyd.dk
- Department of Clinical Research, University of Southern Denmark, and Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.
- Open Patient data Explorative Network, Odense University Hospital, and The OPEN Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Rheumatology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, and Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
CER15751
2023 Vol.41, N°3
PI 0676, PF 0684
Full Papers
Free to view
(click on article PDF icon to read the article)
PMID: 35894059 [PubMed]
Received: 07/04/2022
Accepted : 23/05/2022
In Press: 26/07/2022
Published: 23/03/2023
Abstract
OBJECTIVES:
To investigate the humoral immune response and risk of disease flare in systemic lupus erythematosus (SLE) patients following three-doses of SARS-CoV-2 vaccines.
METHODS:
In adult patients with SLE, we measured SARS-CoV-2 spike IgG in blood samples drawn three weeks after the 1st dose (baseline), four and eight weeks after the 2nd dose and after the 3rd dose. A sufficient antibody response was ≥54BAU/mL. SLEDAI-2K, SLAQ and SDI were assessed at baseline and eight weeks after the 2nd dose along with adverse events. Demographic and treatment data were collected from hospital records.
RESULTS:
Of 123 patients, 115 (93.5%) received the BNT162b2 vaccine, the remaining received the 1st dose of ChAdOx-1 followed by a 2nd and 3rd dose of mRNA-1273. After the 2nd dose 102 (83%) patients had a sufficient antibody response (median 559.2, IQR 288.8-1180.5 BAU/mL), increasing to 115 (93.5%) (median 2416.9, IQR 1289-4603.8 BAU/mL) patients after the 3rd dose. Eight weeks after the 2nd dose patients treated with high dose prednisolone (p=0.034) and DMARDs (p<0.001) had significantly lower antibodies; however, this difference was not significant following the 3rd dose. Disease activity and damage were stable during the study period. Adverse events were more frequent in patients with a sufficient response. Breakthrough infections were reported in 39 (31.7%) patients; all with mild symptoms.
CONCLUSIONS:
A 3rd dose improved the humoral response to SARS-CoV-2 vaccines in patients with SLE to the level of healthy individuals. Vaccination did not affect SLE disease activity. Subsequent breakthrough infections were mild and did not require hospitalisation.
