Patients with rheumatoid arthritis (RA) may have impaired immunogenicity to COVID-19 vaccines. DANBIO data presented by Dr René Cordtz reveal that – regardless of vaccination status – patients with RA had increased incidence of COVID-19 hospitalization compared to matched individuals. However, the absolute risk was 0.20% for unvaccinated patients at 60 days and 0.08% for comparators, whereas it remained below 0.05% at 180 days of follow-up in both groups when fully vaccinated. The low absolute risk was due to the combined effect of vaccination, seasonality, and societal restrictions.
The group also showed that increased SARS-CoV-2 infection rates were seen only among unvaccinated patients with RA. Analysis demonstrated increased incidence of COVID-19 hospitalization among rituximab-treated patients compared to those receiving csDMARDs, but it was not possible to disentangle if this was due to rituximab or the fact that these patients were also more likely to receives glucocorticoids and have a history of cancer-treated patients. Importantly, the parallel decreasing risk for patients with RA suggests a comparable relative benefit of vaccination. Less favourable outcomes among rituximab-treated patients suggest extra care should be taken around use and users of this drug.
Their results showed that those receiving IL-6 inhibitors, abatacept, or rituximab had a significantly lower antibody response rate compared to controls. This difference was more pronounced when therapies were combined with a csDMARD. When analysed further, higher age, rituximab, abatacept, concomitant csDMARD but not IL-6 inhibitors, concomitant prednisolone, or a vasculitis diagnosis, remained significant predictors of antibody response.
Similar conclusions were drawn by a Swedish national group led by Professor Meliha C Kapetanovic and presented by Dr Martina Frodlund, who shared data on the antibody response after two doses of COVID-19 vaccine in 414 patients with various IRD treated with biologic or targeted synthetic DMARDs, either as monotherapy or in combination with csDMARDs.
In general, all vaccines were well tolerated, and only 3.4% of the patients reported an increase in their disease activity following vaccination.
In another session, Dr Ingrid Jyssum presented findings from the Nor-vaC study, assessing serological response and safety of a three-dose vaccination strategy in patients with immune mediated inflammatory diseases (IMID) on immunosuppressive therapy as compared to the standard two-dose vaccination offered to healthy controls.
After two doses, median anti-Spike antibody levels were significantly lower in patients than controls, but there were comparable levels following the third dose. One of the main factors associated with high antibody levels after the third dose was vaccine type. These findings were consistent across all diagnoses and treatment groups, supporting the implementation of a threedose vaccine regimen as standard in the IMID population.