Carruthers Jack E, Wells James, Gupta Arun, Kallon Delordson, Cox Amber, Pina Neuza, Yaqoob Muhammad Magdi, Rajakariar Ravindra
Department of Renal Medicine and Transplantation, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
The Francis Crick Institute, University College London, London, United Kingdom.
Front Med (Lausanne). 2022 Jan 20;8:817845. doi: 10.3389/fmed.2021.817845. eCollection 2021.
Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) present with multisystem disease including renal impairment. The treatment for AAV involves a high burden of immunosuppression. Patients with renal involvement are treated especially intensively. As a result, we identified these patients as being potentially at high risk of failure to seroconvert to COVID-19 vaccination.
We collected data on seroconversion response rates to COVID-19 vaccination in a multi-ethnic cohort of patients with AAV and renal involvement treated at a busy tertiary nephrology centre as part of a retrospective review of patient notes. Blood samples were taken following vaccination with either Pfizer or Astra-Zeneca COVID-19 vaccines and median fluorescence intensity was measured using the validated MULTICOV-Ab Magnetic Luminex Assay. We also evaluated whether seroconversion was affected by immunosuppression regimen.
81 patients were included. The mean age was 62, and there were 49 (60%) females. 55 patients had a blood test after the first dose; 46 after the second dose. Patients were in remission with a median BVAS of 0 (IQR 2). Seroconversion after the first dose with either vaccine was 35/55 (63.6%). After the second it was 38/46 (82.6%). Subgroup analyses revealed a trend to impaired seroconversion in non-white versus white patients (77.8 vs. 81.7% ( = 0.69) after the first dose of vaccine and in those treated with Rituximab in the last 12 months (73.3 vs. 87.1%, = 0.41).
These data offer real-world evidence of lower seroconversion in response to vaccination with one dose in patients with AAV and renal involvement than the general UK population. After two doses, seroconversion is in line with national data. These data provide a rationale for hospital-led identification of patients most at risk of COVID-19 and underscore the importance of local connexions between hospitals and their communities. These data provide further support for targeting booster vaccination programmes to vulnerable patient cohorts. They add to the growing evidence of reduced seroconversion in response to vaccination in patients with renal disease of any cause.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者表现为多系统疾病，包括肾功能损害。AAV的治疗涉及较高的免疫抑制负担。肾脏受累的患者接受的治疗尤为强化。因此，我们认为这些患者可能有较高的新冠病毒疫苗接种血清转化失败风险。
作为对患者病历回顾性研究的一部分，我们收集了在一家繁忙的三级肾脏病中心接受治疗的多民族AAV合并肾脏受累患者队列中新冠病毒疫苗接种血清转化反应率的数据。接种辉瑞或阿斯利康新冠病毒疫苗后采集血样，并使用经过验证的MULTICOV-Ab磁性Luminex检测法测量中位荧光强度。我们还评估了血清转化是否受免疫抑制方案的影响。
纳入81例患者。平均年龄为62岁，女性49例（60%）。55例患者在首剂疫苗接种后进行了血液检测；46例在第二剂后检测。患者病情缓解，中位BVAS为0（四分位距2）。两种疫苗首剂接种后的血清转化率为35/55（63.6%）。第二剂后为38/46（82.6%）。亚组分析显示，非白人患者与白人患者相比，首剂疫苗接种后的血清转化有受损趋势（分别为77.8%和81.7%（P = 0.69）），以及在过去12个月内接受利妥昔单抗治疗的患者中（分别为73.3%和87.1%，P = 0.41）。
这些数据提供了现实世界的证据，表明AAV合并肾脏受累患者接种一剂疫苗后的血清转化率低于英国普通人群。两剂接种后，血清转化率与全国数据一致。这些数据为医院主导识别新冠病毒感染风险最高的患者提供了理论依据，并强调了医院与其社区之间建立本地联系的重要性。这些数据为将加强疫苗接种计划针对易感患者群体提供了进一步支持。它们进一步证明了任何病因的肾病患者接种疫苗后的血清转化率降低。
