COVID-19 and Rheumatology

COVID-19 and Rheumatology

Perspective from April Johnson, APRN, CNP
Disclosures: The researchers report funding from the NIH. Haidar reports research funds from Karius, Inc. Please see the study for all other authors’ relevant financial disclosures.
July 08, 2021
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COVID-19 vaccine response varies widely among immunocompromised patients

Perspective from April Johnson, APRN, CNP
Disclosures: The researchers report funding from the NIH. Haidar reports research funds from Karius, Inc. Please see the study for all other authors’ relevant financial disclosures.
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Approximately 84% of patients with autoimmune diseases develop antibodies from the COVID-19 vaccine, compared with 98.1% of healthy health care workers, according to an interim analysis published in MedRxiv.

The overall findings demonstrate a wide heterogeneity regarding COVID-19 vaccine response in immunocompromised patients, with only one in five participants with a lung transplant developing an antibody response, and a nearly complete response in those with well-controlled HIV, the researchers wrote.

RH0621Haidar_Graphic_01
Roughly 84% of patients with autoimmune diseases develop antibodies from the COVID-19 vaccine, compared with 98.1% of healthy health care workers, according to data derived from Haidar G, et al. MedRxiv. 2021;doi:10.1101/2021.06.28.21259576.

“Not surprisingly, recent studies in transplant, oncology and rheumatology patients have demonstrated that COVID-19 vaccines elicit demonstrable antibody responses well below the 100% response rates seen in healthy volunteers in the reported phase 1/2 trials,” Ghady Haidar, MD, of the University of Pittsburgh School of Medicine, and colleagues wrote. “Despite these emerging data, several unknowns persist, including the degree of the antibody response in seropositive immunocompromised patients, and whether antibodies from immunocompromised patients are capable of neutralizing SARS-CoV-2.”

To analyze antibody responses, levels and neutralization capacity in patients who are immunocompromised after receiving the COVID-19 vaccine, Haidar and colleagues in April 2021 initiated the COVID-19 Vaccination in the Immunocompromised Study (CoVICS). This ongoing observational, prospective cohort study includes 107 healthy health care workers from the University of Pittsburgh Medical Center and 489 immunocompromised adults who completed their COVID-19 vaccination series. Individuals with a history of COVID-19 were excluded.

Researchers collected serum from each participant to measure for the presence of IgG against the SARS-CoV-2 spike protein, based on semi-quantitative assay. In addition, a quasi-random subset of participants was selected for pseudovirus neutralization assays. To identify risk factors for seronegativity, Haidar and colleagues univariately compared clinical characteristics between antibody reactive and non-reactive patients within the immunocompromised group.

According to the researchers, seropositivity was significantly lower (P < .001) in several, but not all, immunocompromised groups compared with the health care workers. Seropositivity rates were 37.2% for patients with solid organ transplant, 83.8% for those with autoimmune disease, 54.7% for those with hematological malignancies and 82.4% with those with solid tumors (P < .05). However, 94.6% of patients with HIV were seropositive.

Among seropositive patients, antibody levels were much lower in those with solid organ transplant (4.5; 95% CI, 2.1-13.1). In addition, neutralization titers closely correlated with antibody levels (Spearman r = 0.91, P < .0001).

“Our study highlights the urgent need to optimize and individualize COVID-19 prevention in patients with immunocompromising conditions and have other treatments — such as monoclonal antibodies — available should vaccination fail,” Haidar said in a press release from the University of Pittsburgh Medical Center. “Given the Centers for Disease Control and Prevention’s recommendations permitting vaccinated people to abandon masking and social distancing in most settings, our findings also have implications for public health guidance, since nearly 4% of Americans are immunocompromised.”

“At this point, clinical advice does not change for immunocompromised people, whether an antibody test is positive or negative,” he added in the release. “They should still wear a mask in public, practice social distancing, get vaccinated and encourage those around them to be vaccinated. A positive antibody test does not give us certainty that they are protected against the virus, and the risk of COVID-19 causing serious complications and death still exists.”