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Revaccination of patients with systemic lupus erythematosus or rheumatoid arthritis without an initial COVID-19 vaccine response elicits seroconversion in half of the patients
C. Ammitzbøll1, M.K. Thomsen2, J.B. Andersen3, J.M.B. Jensen4, R. Bayarri-Olmos5, P. Garred6, M.-L. Hermansen7, A.D. Johannsen8, M.L. Larsen9, C.E. Mistegaard10, S. Mikkelsen11, L. Nielsen12, R. Olesen13, L. Pérez-Alós14, S.R. Vils15, F. Szabados16, O.S. Søgaard17, M. Tolstrup18, C. Erikstrup19, E.-M. Hauge20, A. Troldborg21
- Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. chramm@rm.dk
- Department of Clinical Medicine, Aarhus University, and Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Rheumatology, Horsens Regional Hospital, Horsens, Denmark.
- Department of Clinical Immunology, Aarhus University Hospital, and Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Immunology section 7631, Rigshospitalet, University Hospital of Copenhagen, Denmark.
- Department of Clinical Immunology section 7631, Rigshospitalet, University Hospital of Copenhagen, Denmark.
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Rheumatology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, and Department of Biomedicine, Aarhus University, Aarhus, Denmark.
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Infectious Diseases, Aarhus University, Aarhus, Denmark.
- Department of Infectious Diseases, Aarhus University, Aarhus, Denmark.
- Department of Clinical Immunology section 7631, Rigshospitalet, University Hospital of Copenhagen, Denmark.
- Department of Rheumatology, Aarhus University Hospital, and Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Rheumatology, Hjørring Hospital, Hjørring, Denmark.
- Department of Infectious Diseases, Aarhus University, Aarhus, Denmark.
- Department of Infectious Diseases, Aarhus University, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, and Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University, Aarhus, Denmark.
CER16760
2024 Vol.42, N°1
PI 0157, PF 0165
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PMID: 37877429 [PubMed]
Received: 16/04/2023
Accepted : 19/07/2023
In Press: 23/10/2023
Published: 24/01/2024
Abstract
OBJECTIVES:
To investigate the effect of COVID-19 mRNA revaccination (two doses) on the antibody response in patients with rheumatic diseases (RD) who were initial vaccine non-responders. Further, to examine if B-cell levels or T-cell responses before revaccination predicted seroconversion.
METHODS:
From a RD cohort vaccinated with the standard two-dose COVID-19 vaccinations, we enrolled cases without detectable antibody responses (n=17) and controls with detectable antibody response (n=29). Blood donors (n=32) were included as additional controls. Samples were collected before and six weeks after completed revaccination. Total antibodies and specific IgG, IgA, and IgM against SARS-CoV-2 spike protein, SARS-CoV-2 neutralising antibodies, and SARS-CoV-2 reacting CD4+ and CD8+ T-cells were measured before and after revaccination. B-cells (CD19+CD45+) were quantified before revaccination.
RESULTS:
Forty-seven percent of cases had detectable neutralising antibodies after revaccination. However, antibody levels were significantly lower than in controls and blood donors. Revaccination induced an antibody class switch in cases with a decrease in IgM and increase in IgG. No significant difference was observed in T-cell responses before and after revaccination between the three groups. Only 29% of cases had measurable B-cells compared to 100% of controls and blood donors. Fifty percent of revaccinated cases who seroconverted had measurable B-cells before revaccination.
CONCLUSIONS:
Forty-seven percent of initial non-responders seroconverted after two-dose revaccination but still had lower levels of SARS-CoV-2 antibodies compared with controls and blood donors. RD patients without a detectable serological response after the initial COVID-19 mRNA vaccine had a T-cell response similar to immunocompetent controls and blood donors.
