Department of Rheumatology, Hôpital Lyon Sud, Hospices Civils de Lyon, INSERM UMR -1033, Pathophysiology, diagnosis and treatments of muskuloskeletal disorders, Claude Bernard University Lyon 1, Lyon, France.
Department of Internal and Vascular Medicine, Hôpital Lyon Sud, Hospices Civils de Lyon, RESHAPE-INSERM U1290, Research on Healthcare Performance, Claude Bernard University Lyon 1, Lyon, France.
Joint Bone Spine. 2022 Oct;89(5):105380. doi: 10.1016/j.jbspin.2022.105380. Epub 2022 Apr 28.
Vaccination is considered as a cornerstone of the management of COVID-19 pandemic. However, while vaccines provide a robust protection in immunocompetent individuals, the immunogenicity in patients with inflammatory rheumatic diseases (IRD) is not well established.
A monocentric observational study evaluated the immunogenicity of a two-dose regimen vaccine in adult patients with IRD (n=123) treated with targeted or biological therapies. Serum IgG antibody levels against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins were measured after the second vaccination. In addition, a search for observational studies performed in IRD under biologic or targeted therapies up to September 31, 2021 (PROSPERO registration number: CRD42021259410) was undertaken in publication databases, preprint servers, and grey literature sources. Studies that reported sample size, study date, location, and seroprevalence estimate were included. A meta-analysis was conducted to identify demographic differences in the prevalence of SARS-CoV-2 antibodies.
Of 123 patients (median age 66 IQR 57-75), 69.9% have seroconverted after vaccination. Seroconverted patients were older than non-seroconverted ones in our cohort. Rituximab was associated with a significantly low antibody response. Besides, we identified 20 seroprevalence studies in addition to our cohort including 4423 participants in 11 countries. Meta-analysis confirmed a negative impact of rituximab on seroconversion rate and suggested a less substantial effect of abatacept, leflunomide and methotrexate.
Rituximab impairs serological response to SARS-CoV-2 vaccines in patients with IRD. This work suggests also a negative impact of abatacept, methotrexate or leflunomide especially when associated to biological therapy.
接种疫苗被认为是管理 COVID-19 大流行的基石。然而，尽管疫苗在免疫功能正常的个体中提供了强大的保护，但在炎症性风湿病（IRD）患者中的免疫原性尚未得到充分证实。
一项单中心观察性研究评估了靶向或生物治疗的成年 IRD 患者（n=123）接受两剂疫苗方案的免疫原性。在第二次接种后测量针对严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）刺突蛋白的血清 IgG 抗体水平。此外，在出版物数据库、预印本服务器和灰色文献来源中，对截至 2021 年 9 月 31 日（PROSPERO 注册号：CRD42021259410）在生物或靶向治疗下进行的 IRD 的观察性研究进行了检索。纳入报告样本量、研究日期、地点和血清阳性率估计值的研究。进行荟萃分析以确定 SARS-CoV-2 抗体阳性率的人口统计学差异。
在 123 名患者（中位数年龄 66 IQR 57-75）中，69.9%的患者接种疫苗后发生血清转化。我们的队列中，血清转化患者比未血清转化患者年龄更大。利妥昔单抗与抗体反应显著降低相关。此外，除了我们的队列外，我们还确定了 20 项血清阳性率研究，包括 11 个国家的 4423 名参与者。荟萃分析证实利妥昔单抗对血清转化率有负面影响，并表明阿巴西普、来氟米特和甲氨蝶呤的影响较小。
利妥昔单抗会削弱 IRD 患者对 SARS-CoV-2 疫苗的血清学反应。这项工作还表明阿巴西普、甲氨蝶呤或来氟米特也有负面影响，尤其是当与生物治疗联合使用时。
