Produção Nacional
Revisado por pares
Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis
2022; BMJ; Volume: 81; Issue: 5 Linguagem: Inglês
10.1136/annrheumdis-2021-221735
ISSN1468-2060
AutoresAna Cristina de Medeiros Ribeiro, Karina Rossi Bonfiglioli, Diogo Souza Domiciano, Andrea Yukie Shimabuco, Henrique Carriço da Silva, Carla Gonçalves Schahin Saad, Emily Figueiredo Neves Yuki, Sandra Gofinet Pasoto, Carlo Scognamiglio Renner Araújo, Tatiane Lie Nakai, Clóvis A. Silva, Tatiana do Nascimento Pedrosa, Léonard de Vinci Kanda Kupa, Matheus Santos Rodrigues Silva, Guilherme Guimarães Moreira Balbi, Esper G. Kallás, Nádia Emi Aikawa, Eloísa Bonfá,
Tópico(s)Rheumatoid Arthritis Research and Therapies
ResumoObjectives To evaluate the distinct impact of disease modifying antirheumatic drugs (DMARD) combination and monotherapy in immune response to an inactivated SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA). Methods This phase 4 prospective study analysed seroconversion (SC) of anti-SARS-CoV-2 immunoglobulin G (IgG) and neutralising antibodies (NAb) induced by the inactivated vaccine (CoronaVac) in patients with RA in comparison to controls (CG). Disease activity and treatment were also assessed. Only participants with baseline negative IgG/NAb were included. Results Patients with RA (N=260) and CG (N=104) had comparable median ages (59 years (50–65 years) vs 58 years (49.8–64 years), p=0.483). Patients with RA had moderate but lower SC (61.8% vs 94.2%, p<0.001) and NAb positivity (45% vs 78.6%, p<0.001) in comparison to CG after full vaccination. Baseline disease activity did not influence immunogenicity (p>0.05). After multivariate analyses, factors independently related to reduced SC were: older age (OR=0.79 (0.70–0.89) for each 5-year interval, p<0.001), methotrexate (OR=0.54 (0.29–0.98), p=0.044), abatacept (OR=0.37 (0.19–0.73), p=0.004) and number of DMARD (OR=0.55 (0.33–0.90), p=0.018). Regarding NAb, age (OR=0.87 (0.78–0.96) for each 5-year interval, p=0.007) and prednisone >7.5 mg/day (OR=0.38 (0.19–0.74), p=0.004) were negatively related to the presence of NAb. Further comparison of SC/NAb positivity among RA treatment subgroups and CG revealed that methotrexate/tofacitinib/abatacept/tocilizumab use, in monotherapy or in combination, resulted in lower responses (p<0.05), while tumour necrosis factor inhibitor and other conventional synthetic DMARD interfered solely when combined with other therapies. Conclusions Patients with RA under DMARD have a moderate immunogenicity to CoronaVac. We identified that nearly all DMARD combinations have a deleterious effect in immunogenicity, whereas a more restricted number of drugs (methotrexate/tofacitinib/abatacept/tocilizumab) also hampered this response as monotherapy. These findings reinforce the need of a broader approach, not limited to specific drugs, to improve vaccine response for this population. Trial registration details NCT04754698 .
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