Larsen Emilie Stavnsbjerg, Nilsson Anna Christine, Möller Sören, Voss Anne Boertmann, Johansen Isik Somuncu
Department of Rheumatology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark; and Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, and Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.
Clin Exp Rheumatol. 2023 Mar;41(3):676-684. doi: 10.55563/clinexprheumatol/b8a6zb. Epub 2022 Jul 26.
To investigate the humoral immune response and risk of disease flare in systemic lupus erythematosus (SLE) patients following three-doses of SARS-CoV-2 vaccines.
In adult patients with SLE, we measured SARS-CoV-2 spike IgG in blood samples drawn three weeks after the 1st dose (baseline), four and eight weeks after the 2nd dose and after the 3rd dose. A sufficient antibody response was ≥54BAU/mL. SLEDAI-2K, SLAQ and SDI were assessed at baseline and eight weeks after the 2nd dose along with adverse events. Demographic and treatment data were collected from hospital records.
Of 123 patients, 115 (93.5%) received the BNT162b2 vaccine, the remaining received the 1st dose of ChAdOx-1 followed by a 2nd and 3rd dose of mRNA-1273. After the 2nd dose 102 (83%) patients had a sufficient antibody response (median 559.2, IQR 288.8-1180.5 BAU/mL), increasing to 115 (93.5%) (median 2416.9, IQR 1289-4603.8 BAU/mL) patients after the 3rd dose. Eight weeks after the 2nd dose patients treated with high dose prednisolone (p=0.034) and DMARDs (p<0.001) had significantly lower antibodies; however, this difference was not significant following the 3rd dose. Disease activity and damage were stable during the study period. Adverse events were more frequent in patients with a sufficient response. Breakthrough infections were reported in 39 (31.7%) patients; all with mild symptoms.
A 3rd dose improved the humoral response to SARS-CoV-2 vaccines in patients with SLE to the level of healthy individuals. Vaccination did not affect SLE disease activity. Subsequent breakthrough infections were mild and did not require hospitalisation.
研究系统性红斑狼疮（SLE）患者接种三剂严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗后的体液免疫反应及疾病复发风险。
在成年SLE患者中，我们在第1剂疫苗接种后3周（基线）、第2剂疫苗接种后4周和8周以及第3剂疫苗接种后采集血样，检测其中SARS-CoV-2刺突蛋白IgG。充分的抗体反应为≥54 BAU/mL。在基线以及第2剂疫苗接种后8周评估SLE疾病活动指数2000（SLEDAI-2K）、系统性红斑狼疮问卷（SLAQ）和系统性红斑狼疮损伤指数（SDI），并记录不良事件。从医院记录中收集人口统计学和治疗数据。
123例患者中，115例（93.5%）接种了BNT162b2疫苗，其余患者第1剂接种了ChAdOx-1疫苗，随后第2剂和第3剂接种了mRNA-1273疫苗。第2剂疫苗接种后，102例（83%）患者产生了充分的抗体反应（中位数为559.2，四分位间距为288.8 - 1180.5 BAU/mL），第3剂疫苗接种后，这一比例增至115例（93.5%）（中位数为2416.9，四分位间距为1289 - 4603.8 BAU/mL）。第2剂疫苗接种后8周，接受高剂量泼尼松龙治疗的患者（p = 0.034）和接受疾病修正抗风湿药物（DMARDs）治疗的患者（p < 0.001）抗体水平显著较低；然而，第3剂疫苗接种后这种差异并不显著。研究期间疾病活动度和损伤情况保持稳定。抗体反应充分的患者不良事件更为频繁。39例（31.7%）患者报告了突破性感染；所有患者症状均较轻。
第3剂疫苗接种可使SLE患者对SARS-CoV-2疫苗的体液反应提高到健康个体的水平。疫苗接种未影响SLE疾病活动度。随后发生的突破性感染症状较轻，无需住院治疗。
