Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, 1724University of Birmingham, Birmingham, UK.
Rheumatology Department, 1731Sandwell and West Birmingham NHS Trust, Birmingham UK.
Lupus. 2023 Mar;32(3):431-437. doi: 10.1177/09612033231151603. Epub 2023 Jan 11.
Patients with Systemic Lupus Erythematosus are known to have dysregulated immune responses and may have reduced response to vaccination against COVID-19 while being at risk of severe COVID-19 disease. The aim of this study was to identify whether vaccine responses were attenuated in SLE and to assess disease- and treatment-specific associations.
Patients with SLE were matched by age, sex and ethnic background to healthcare worker healthy controls (HC). Anti-SARS-CoV-2 spike glycoprotein antibodies were measured at 4-8 weeks following the second COVID-19 vaccine dose (either BNT162b2 or ChAdOx1 nCoV-19) using a CE-marked combined ELISA detecting IgG, IgA and IgM (IgGAM). Antibody levels were considered as a continuous variable and in tertiles and compared between SLE patients and HC and associations with medication, disease activity and serological parameters were determined.
Antibody levels were lower in 43 SLE patients compared to 40 HC ( < 0.001). There was no association between antibody levels and medication, lupus disease activity, vaccine type or prior COVID infection. Higher serum IgA, but not IgG or IgM, was associated with being in a higher anti-SARS-CoV-2 antibody level tertile (OR [95% CI] 1.820 [1.050, 3.156] = 0.033). Similarly, higher lymphocyte count was also associated with being in a higher tertile of anti-SARS-CoV-2 (OR 3.330 [1.505, 7.366] = 0.003).
Patients with SLE have lower antibody levels following 2 doses of COVID-19 vaccines compared to HC. In SLE lower lymphocyte counts and serum IgA levels are associated with lower antibody levels post vaccination, potentially identifying a subgroup of patients who may therefore be at increased risk of infection.
患有系统性红斑狼疮的患者其免疫反应失调，而 COVID-19 疫苗对他们的效果可能不如健康人群，并且他们患重症 COVID-19 的风险较高。本研究旨在确定 SLE 患者的疫苗反应是否减弱，并评估疾病和治疗的具体关联。
通过年龄、性别和种族背景与医疗保健工作者健康对照（HC）相匹配，在接种第二剂 COVID-19 疫苗（BNT162b2 或 ChAdOx1 nCoV-19）后 4-8 周，使用一种经 CE 标记的联合 ELISA 检测 IgG、IgA 和 IgM（IgGAM）来测量抗 SARS-CoV-2 刺突糖蛋白抗体。抗体水平被视为连续变量，并在三分位数中进行比较，以确定与药物、疾病活动度和血清学参数的关联。
与 40 名 HC 相比，43 名 SLE 患者的抗体水平较低（<0.001）。抗体水平与药物、狼疮疾病活动度、疫苗类型或既往 COVID 感染之间无关联。更高的血清 IgA，但不是 IgG 或 IgM，与更高的抗 SARS-CoV-2 抗体水平三分位数相关（OR [95%CI] 1.820 [1.050, 3.156] = 0.033）。同样，更高的淋巴细胞计数也与更高的抗 SARS-CoV-2 三分位数相关（OR 3.330 [1.505, 7.366] = 0.003）。
与 HC 相比，SLE 患者在接种两剂 COVID-19 疫苗后抗体水平较低。在 SLE 中，较低的淋巴细胞计数和血清 IgA 水平与接种疫苗后的较低抗体水平相关，这可能确定了一个亚组患者，他们因此可能面临更高的感染风险。
