New York University Grossman School of Medicine, New York, New York.
Albert Einstein College of Medicine, New York, New York.
Arthritis Rheumatol. 2022 Feb;74(2):284-294. doi: 10.1002/art.41937. Epub 2021 Dec 28.
To evaluate seroreactivity and disease flares after COVID-19 vaccination in a multiethnic/multiracial cohort of patients with systemic lupus erythematosus (SLE).
Ninety SLE patients and 20 healthy controls receiving a complete COVID-19 vaccine regimen were included. IgG seroreactivity to the SARS-CoV-2 spike receptor-binding domain (RBD) and SARS-CoV-2 microneutralization were used to evaluate B cell responses; interferon-γ (IFNγ) production was measured by enzyme-linked immunospot (ELISpot) assay in order to assess T cell responses. Disease activity was measured by the hybrid SLE Disease Activity Index (SLEDAI), and flares were identified according to the Safety of Estrogens in Lupus Erythematosus National Assessment-SLEDAI flare index.
Overall, fully vaccinated SLE patients produced significantly lower IgG antibodies against SARS-CoV-2 spike RBD compared to fully vaccinated controls. Twenty-six SLE patients (28.8%) generated an IgG response below that of the lowest control (<100 units/ml). In logistic regression analyses, the use of any immunosuppressant or prednisone and a normal anti-double-stranded DNA antibody level prior to vaccination were associated with decreased vaccine responses. IgG seroreactivity to the SARS-CoV-2 spike RBD strongly correlated with the SARS-CoV-2 microneutralization titers and correlated with antigen-specific IFNγ production determined by ELISpot. In a subset of patients with poor antibody responses, IFNγ production was similarly diminished. Pre- and postvaccination SLEDAI scores were similar in both groups. Postvaccination flares occurred in 11.4% of patients; 1.3% of these were severe.
In a multiethnic/multiracial study of SLE patients, 29% had a low response to the COVID-19 vaccine which was associated with receiving immunosuppressive therapy. Reassuringly, severe disease flares were rare. While minimal protective levels remain unknown, these data suggest that protocol development is needed to assess the efficacy of booster vaccination.
评估 COVID-19 疫苗接种后在系统性红斑狼疮（SLE）的多民族/多种族队列中患者的血清反应性和疾病发作。
纳入了 90 名 SLE 患者和 20 名接受完整 COVID-19 疫苗接种方案的健康对照者。使用针对 SARS-CoV-2 刺突受体结合域（RBD）的 IgG 血清反应性和 SARS-CoV-2 微量中和来评估 B 细胞反应；通过酶联免疫斑点（ELISpot）测定来测量干扰素-γ（IFNγ）的产生，以评估 T 细胞反应。通过混合性 SLE 疾病活动指数（SLEDAI）来衡量疾病活动，根据雌激素在红斑狼疮中的安全性评估-SLEDAI 发作指数来识别发作。
总体而言，与完全接种疫苗的对照组相比，完全接种疫苗的 SLE 患者对 SARS-CoV-2 刺突 RBD 的 IgG 抗体产生明显较低。26 名 SLE 患者（28.8％）产生的 IgG 反应低于最低对照组（<100 单位/毫升）。在逻辑回归分析中，接种疫苗前使用任何免疫抑制剂或泼尼松以及抗双链 DNA 抗体水平正常与疫苗反应降低有关。针对 SARS-CoV-2 刺突 RBD 的 IgG 血清反应性与 SARS-CoV-2 微量中和滴度强烈相关，并且与通过 ELISpot 确定的抗原特异性 IFNγ产生相关。在抗体反应不良的患者亚组中，IFNγ的产生也同样减少。两组患者的接种前后 SLEDAI 评分相似。接种后有 11.4％的患者发生了发作，其中 1.3％为严重发作。
在 SLE 患者的多民族/多种族研究中，29％的患者对 COVID-19 疫苗的反应较低，这与接受免疫抑制治疗有关。令人欣慰的是，严重疾病发作很少见。虽然最小的保护水平尚不清楚，但这些数据表明需要制定方案来评估加强疫苗接种的效果。
