1. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine response in adults with predominantly antibody deficiency
- Author
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Anna M. Zhang, MD, Ahmed Elmoursi, MD, MPH, Daniel V. DiGiacomo, MD, MPH, Baijun Zhou, MHS, Megha Tandon, BA, Joseph S. Hong, BS, Nancy J. Yang, BS, Mei-Sing Ong, PhD, Anand S. Dighe, MD, PhD, Cristhian Berrios, MD, Mark C. Poznansky, MD, PhD, Anthony J. Iafrate, MD, PhD, Vivek Naranbhai, PhD, MB, ChB, Alejandro Balazs, PhD, Shiv Pillai, MBBS, PhD, Jocelyn R. Farmer, MD, PhD, and Sara Barmettler, MD
- Subjects
Predominantly antibody deficiency ,SARS-CoV-2 ,common variable immunodeficiency ,anti-spike antibody ,Omicron BA.5 variant ,neutralization ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Background: Patients with predominantly antibody deficiency (PAD) have lower anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike antibody levels after initial 2-dose SARS-CoV-2 vaccination than healthy controls do; however, the anti-spike antibody responses and neutralization function in patients with PAD following subsequent immunizations remain understudied. Objective: We sought to characterize anti-spike antibody responses in adults with PAD over the course of 5 SARS-CoV-2 vaccine doses and identify diagnostic and immunophenotypic risk factors for low antibody response. Methods: We evaluated anti-spike antibody levels in 117 adult patients with PAD and 192 adult healthy controls following a maximum of 5 SARS-CoV-2 immunizations. We assessed neutralization of the SARS-CoV-2 wild-type strain and the Omicron BA.5 variant and analyzed infection outcomes. Results: The patients with PAD had significantly lower mean anti-spike antibody levels after 3 SARS-CoV-2 vaccine doses than the healthy controls did (1,439.1 vs 21,890.4 U/mL [P < .0001]). Adults with secondary PAD, severe primary PAD, and high-risk immunophenotypes had lower mean anti-spike antibody levels following vaccine doses 2, 3, and/or 4 but not following vaccine dose 5. Compared with patients with mild and moderate PAD, patients with severe PAD had a higher rate of increase in anti-spike antibody levels over 5 immunizations. A strong positive correlation was observed between anti-spike antibody levels and neutralization of both the SARS-CoV-2 wild-type strain and the Omicron BA.5 variant. Most infections were managed on an outpatient basis. Conclusions: In all of the patients with PAD, anti-spike antibody levels increased with successive SARS-CoV-2 immunizations and were correlated with neutralization of both the SARS-CoV-2 wild-type strain and the Omicron BA.5 variant. Secondary PAD, severe primary PAD, and high-risk immunophenotypes were correlated with lower mean anti-spike antibody levels following vaccine doses 2 through 4. Patients with severe PAD had the highest rate of increase in anti-spike antibody levels over 5 immunizations. These data suggest a clinical benefit to sequential SARS-CoV-2 immunizations, particularly among high-risk patients with PAD.
- Published
- 2024
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