COVID-19 疫苗初始接种后，全身性风湿性疾病患者低 Spike 抗体反应的预测因素。
Predictors of low spike antibody response in patients with systemic rheumatic disease after an initial course of COVID-19 vaccination.
机构信息
Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Suite 6016, Boston, MA, 02115, USA.
Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA.
出版信息
Clin Rheumatol. 2023 Jun;42(6):1695-1700. doi: 10.1007/s10067-023-06512-z. Epub 2023 Jan 19.
BACKGROUND
Patients with rheumatic disease may mount a suboptimal serologic response to COVID-19 vaccination. We evaluated predictors of low antibody response in a clinic-based cohort.
METHODS
We conducted a cross-sectional study using electronic health record (EHR) data at Brigham and Women's Hospital, Boston, MA. Patients with systemic rheumatic disease that had SARS-CoV-2 spike antibody (Ab) tested using the Roche Elecsys immunoassay, February-August 2021, after 2 doses of mRNA vaccine or 1 dose of adenovirus vector vaccine were identified. Demographics, systemic rheumatic disease, vaccination dates, and disease-modifying antirheumatic drugs (DMARDs) were extracted. The primary outcome was low spike Ab (≤ 200 U/mL). Logistic regression models estimated predictors of low spike Ab.
RESULTS
Among 382 patients, the mean age was 57 years, 77% were female, and 37% had low spike Ab. Older age (OR 1.03, 95% CI [1.02, 1.05]), SLE (OR 4.81 [2.08, 8.43], reference: inflammatory arthritis), prednisone (OR 1.67 [1.03, 2.74]), and rituximab (OR 22.91 [9.85, 53.29]) were significantly associated with higher odds of low spike Ab. Use of csDMARD monotherapy (OR 0.12 [0.04, 0.33]) and JAK inhibitors (OR 0.41 [0.18, 0.92]) were associated with significantly lower odds for low spike Ab. After adjusting for systemic rheumatic disease and DMARDs, SLE and rituximab remained significantly associated with low spike Ab.
CONCLUSIONS
Over a third of patients with systemic rheumatic disease with spike Ab tested in routine care had low spike Ab after 2 doses of mRNA or 1 dose of adenovirus vector COVID-19 vaccine. SLE and rituximab were significant risk factors for low spike Ab.
KEY POINTS
• More than one-third of patients with systemic rheumatic disease that had spike Ab tested in routine care had low spike Ab after 2 doses of mRNA or 1 dose of adenovirus vector COVID-19 vaccine. • Diagnosis of SLE, use of prednisone, and use of rituximab were significantly associated with greater odds of low spike antibodies. • These data underscore the importance of additional doses of COVID-19 vaccine and prophylactic Evusheld in immunosuppressed patients with systemic rheumatic disease as recommended by the US Centers for Disease Control.
背景
患有风湿性疾病的患者可能对 COVID-19 疫苗产生不理想的血清学反应。我们评估了基于诊所队列中低抗体反应的预测因素。
方法
我们在波士顿布莱根妇女医院使用电子健康记录（EHR）数据进行了一项横断面研究。2021 年 2 月至 8 月，在接受 2 剂 mRNA 疫苗或 1 剂腺病毒载体疫苗后，使用罗氏 Elecsys 免疫分析法检测了系统性风湿性疾病患者的 SARS-CoV-2 刺突抗体（Ab），并确定了这些患者。提取了人口统计学，系统性风湿性疾病，疫苗接种日期和疾病修饰抗风湿药物（DMARD）的数据。主要结局是低刺突 Ab（≤200 U/mL）。使用逻辑回归模型估算了低刺突 Ab 的预测因素。
结果
在 382 例患者中，平均年龄为 57 岁，77％为女性，37％的患者刺突 Ab 水平较低。年龄较大（OR 1.03，95％CI [1.02，1.05]），SLE（OR 4.81 [2.08，8.43]，参考：炎性关节炎），泼尼松（OR 1.67 [1.03，2.74]）和利妥昔单抗（OR 22.91 [9.85，53.29]）与较高的低刺突 Ab 几率显着相关。使用 csDMARD 单药治疗（OR 0.12 [0.04，0.33]）和 JAK 抑制剂（OR 0.41 [0.18，0.92]）与低刺突 Ab 的几率显着降低相关。在调整了系统性风湿性疾病和 DMARD 后，SLE 和利妥昔单抗仍与低刺突 Ab 显着相关。
结论
在常规护理中接受刺突 Ab 检测的系统性风湿性疾病患者中，超过三分之一的患者在接受 2 剂 mRNA 或 1 剂腺病毒载体 COVID-19 疫苗后刺突 Ab 水平较低。SLE 和利妥昔单抗是低刺突 Ab 的重要危险因素。
关键点
在常规护理中接受刺突 Ab 检测的系统性风湿性疾病患者中，超过三分之一的患者在接受 2 剂 mRNA 或 1 剂腺病毒载体 COVID-19 疫苗后刺突 Ab 水平较低。
SLE、泼尼松和利妥昔单抗的诊断与较高的低刺突抗体几率显着相关。
这些数据强调了美国疾病控制与预防中心推荐的，在接受免疫抑制治疗的系统性风湿性疾病患者中，应追加 COVID-19 疫苗剂量和预防性使用 Evusheld 的重要性。
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