Yang, Lu M., Costales, Cristina, Ramanathan, Muthukumar, Bulterys, Philip L., Murugesan, Kanagavel, Schroers-Martin, Joseph, Alizadeh, Ash A., Boyd, Scott D., Brown, Janice M., Nadeau, Kari C., Nadimpalli, Sruti S., Wang, Aileen X., Busque, Stephan, Pinsky, Benjamin A., and Banaei, Niaz
• Both cellular and humoral immune responses to SARS-CoV-2 vaccination wane over time. • The rate of vaccine response decline is comparable between immunosuppressed patients and healthy populations. • S1P receptor modulators and mycophenolate are associated with lower cellular and humoral immune response. • Anti-CD20 therapy is associated with lower humoral immune response only. • 35% of patients with poor humoral response after primary vaccination had a significantly increased humoral response after receiving the booster. : Humoral and cellular immune responses to SARS-CoV-2 vaccination among immunosuppressed patients remain poorly defined, as well as variables associated with poor response. : We performed a retrospective observational cohort study at a large Northern California healthcare system of infection-naïve individuals fully vaccinated against SARS-CoV-2 (mRNA-1273, BNT162b2, or Ad26.COV2.S) with clinical SARS-CoV-2 interferon gamma release assay (IGRA) ordered between January through November 2021. Humoral and cellular immune responses were measured by anti-SARS-CoV-2 S1 IgG ELISA (anti-S1 IgG) and IGRA, respectively, following primary and/or booster vaccination. : 496 immunosuppressed patients (54% female; median age 50 years) were included. 62% (261/419) of patients had positive anti-S1 IgG and 71% (277/389) had positive IGRA after primary vaccination, with 20% of patients having a positive IGRA only. Following booster, 69% (81/118) had positive anti-S1 IgG and 73% (91/124) had positive IGRA. Factors associated with low humoral response rates after primary vaccination included anti-CD20 monoclonal antibodies (P < 0.001), sphingosine 1-phsophate (S1P) receptor modulators (P < 0.001), mycophenolate (P = 0.002), and B cell lymphoma (P = 0.004); those associated with low cellular response rates included S1P receptor modulators (P < 0.001) and mycophenolate (P < 0.001). Of patients who had poor humoral response to primary vaccination, 35% (18/52) developed a significantly higher response after the booster. Only 5% (2/42) of patients developed a significantly higher cellular response to the booster dose compared to primary vaccination. : Humoral and cellular response rates to primary and booster SARS-CoV-2 vaccination differ among immunosuppressed patient groups. Clinical testing of cellular immunity is important in monitoring vaccine response in vulnerable populations. [ABSTRACT FROM AUTHOR]