February 23, 2022
2 min read
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Information: Shenoy does not report any relevant financial information. Co-author Sakir AhmedMD, DM, from the Kalinga Institute of Medical Sciences, reports speech fees from Pfizer, DrReddy’s, Cipla and Novartis.
Lack of antibody response after COVID-19 vaccination is the strongest predictor of breakthrough infection in patients with autoimmune arthritis, according to data published in Annals of the rheumatic diseases.
“Patients with autoimmune rheumatic diseases (AIRD) have reduced response to COVID-19 vaccination,” Padmanabha Shenoy, MD, DM, from the Center for Arthritis and Rheumatism Excellence (CARE), in Cochin, India, Healio said. “There is no biomarker to predict successful vaccination, and current recommendations do not support the use of antibody titers to measure COVID-19 protection.”
To analyze the occurrence and risk factors for breakthrough of COVID-19 infection in patients with autoimmune rheumatic disease, Shenoy and colleagues prospectively followed 630 fully vaccinated patients from the Center for Arthritis and Rheumatism Excellence in southern India. All participants had been diagnosed with an autoimmune arthritis disease and completed two doses of a SARS-CoV2 vaccine. Individuals with previous COVID-19 infection were excluded. Registration began in March 2021, with follow-up ending in October 2021.
The researchers evaluated antibodies to the receptor binding domain of nail protein (anti-RBD) in all participants 4 to 6 weeks after the second dose of vaccine. Participants were then stratified based on antibody response, with “good responders” showing more than 212 IU, “insufficient responders” ranging from 0.8 to 212 IU, and those with less than 0.8 IU identified as “non-responders”. . At a minimum of 8 weeks after vaccination, patients were followed up every 2 months to identify groundbreaking COVID-19 infection. In addition, all seroconverted participants who had contact with COVID-19 were tested for neutralizing antibodies.
Among the 630 participants, 78.6% received the AstraZeneca AZD1222 vaccine, while the remaining received the BBV152 vaccine, developed by Bharat Biotech International in India. The mean age of the participants was 55.2 years.
According to the researchers, the average antibody titer after vaccination was 854.1, with 60.3% identified as “good responders”, 22.7% as “inadequate responders” and 16.9% were considered “non-responders”.
In total, breakthrough COVID-19 infection occurred in 7.4% of participants at a mean follow-up of 147.3 days. Breakthrough cases were proportionally highest among non-responders with 17.75% followed by inadequate respondents with 9.09%. Only 3.95% of the good respondents experienced a breakthrough of COVID-19. In a log-rank analysis, the researchers found that antibody response (P <.00001), vaccine type (P = .003) and use of mycophenolate mofetil (P = .007) were significant predictors of breakthrough infection. However, in the multivariate Cox regression, only vaccine non-response was significantly associated with breakthrough COVID-19 infection (HR = 3.6; 95% CI, 1.58-8).
Among patients who were seroconverted and had contact with COVID-19, neutralization levels varied between those who did and did not develop infection.
“We showed that patients with AIRD with low anti-spike antibody titers have higher risk of breakthrough infections“said Shenoy.” The study provides an inexpensive and widely available biomarker for estimating vaccination success. We do not need complicated T-cell assays – only antibody levels are sufficient as a prediction. Patients with inadequate anti-spike antibody titers should be protected against infection and given priority to booster doses. “