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Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis

Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis

Authors :
Ana Cristina Medeiros-Ribeiro
Karina Rossi Bonfiglioli
Diogo Souza Domiciano
Andrea Yukie Shimabuco
Henrique Carriço da Silva
Carla G S Saad
Emily Figueiredo Neves Yuki
Sandra Gofinet Pasoto
Carlo Scognamiglio Renner Araujo
Tatiane Lie Nakai
Clóvis Artur Silva
Tatiana Pedrosa
Léonard de Vinci Kanda Kupa
Matheus Santos Rodrigues Silva
Guilherme Guimarães Moreira Balbi
Esper Georges Kallas
Nádia Emi Aikawa
Eloisa Bonfa
Source :
Annals of the rheumatic diseases. 81(5)
Publication Year :
2021

Abstract

ObjectivesTo evaluate the distinct impact of disease modifying antirheumatic drugs (DMARD) combination and monotherapy in immune response to an inactivated SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA).MethodsThis phase 4 prospective study analysed seroconversion (SC) of anti-SARS-CoV-2 immunoglobulin G (IgG) and neutralising antibodies (NAb) induced by the inactivated vaccine (CoronaVac) in patients with RA in comparison to controls (CG). Disease activity and treatment were also assessed. Only participants with baseline negative IgG/NAb were included.ResultsPatients with RA (N=260) and CG (N=104) had comparable median ages (59 years (50–65 years) vs 58 years (49.8–64 years), p=0.483). Patients with RA had moderate but lower SC (61.8% vs 94.2%, p0.05). After multivariate analyses, factors independently related to reduced SC were: older age (OR=0.79 (0.70–0.89) for each 5-year interval, p7.5 mg/day (OR=0.38 (0.19–0.74), p=0.004) were negatively related to the presence of NAb. Further comparison of SC/NAb positivity among RA treatment subgroups and CG revealed that methotrexate/tofacitinib/abatacept/tocilizumab use, in monotherapy or in combination, resulted in lower responses (pConclusionsPatients with RA under DMARD have a moderate immunogenicity to CoronaVac. We identified that nearly all DMARD combinations have a deleterious effect in immunogenicity, whereas a more restricted number of drugs (methotrexate/tofacitinib/abatacept/tocilizumab) also hampered this response as monotherapy. These findings reinforce the need of a broader approach, not limited to specific drugs, to improve vaccine response for this population.Trial registration detailsNCT04754698.

Details

ISSN :
14682060
Volume :
81
Issue :
5
Database :
OpenAIRE
Journal :
Annals of the rheumatic diseases
Accession number :
edsair.doi.dedup.....3b334bb11f6702754f302f9996991e7e