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Increment of immunogenicity after third dose of a homologous inactivated SARS-CoV-2 vaccine in a large population of patients with autoimmune rheumatic diseases

2022; BMJ; Volume: 81; Issue: 7 Linguagem: Inglês

10.1136/annrheumdis-2021-222096

1468-2060

Nádia Emi Aikawa, Léonard de Vinci Kanda Kupa, Ana Cristina de Medeiros Ribeiro, Carla Gonçalves Schahin Saad, Emily Figueiredo Neves Yuki, Sandra Gofinet Pasoto, Priscila Tagliaferro Rojo, Rosa Maria Rodrigues Pereira, Samuel Katsuyuki Shinjo, Percival D. Sampaio‐Barros, Danieli Andrade, Ari Stiel Radu Halpern, Ricardo Fuller, Fernando Henrique Carlos de Souza, Lissiane Karine Noronha Guedes, Ana Paula Luppino Assad, Júlio César Bertacini de Moraes, Michelle Remião Ugolini‐Lopes, Victor Adriano de Oliveira Martins, Lorena Betancourt, Carolina Torres Ribeiro, Lucas Peixoto Sales, Isabela Maria Bertoglio, Virgínia Lúcia Nazário Bonoldi, Renata Lys Pinheiro Mello, Gustavo Guimarães Moreira Balbi, Ana Marli Christovam Sartori, Leila Antonângelo, Clóvis A. Silva, Eloísa Bonfá,

Peripheral Neuropathies and Disorders

Objective To determine the immunogenicity of the third dose of CoronaVac vaccine in a large population of patients with autoimmune rheumatic diseases (ARD) and the factors associated with impaired response. Methods Adult patients with ARD and age-balanced/sex-balanced controls (control group, CG) previously vaccinated with two doses of CoronaVac received the third dose at D210 (6 months after the second dose). The presence of anti-SARS-CoV-2 S1/S2 IgG and neutralising antibodies (NAb) was evaluated previously to vaccination (D210) and 30 days later (D240). Patients with controlled disease suspended mycophenolate mofetil (MMF) for 7 days or methotrexate (MTX) for 2 weekly doses after vaccination. Results ARD (n=597) and CG (n=199) had comparable age (p=0.943). Anti-S1/S2 IgG seropositivity rates significantly increased from D210 (60%) to D240 (93%) (p<0.0001) in patients with ARD. NAb positivity also increased: 38% (D210) vs 81.4% (D240) (p<0.0001). The same pattern was observed for CG, with significantly higher frequencies for both parameters at D240 (p<0.05). Multivariate logistic regression analyses in the ARD group revealed that older age (OR=0.98, 95% CI 0.96 to 1.0, p=0.024), vasculitis diagnosis (OR=0.24, 95% CI 0.11 to 0.53, p<0.001), prednisone ≥5 mg/day (OR=0.46, 95% CI 0.27 to 0.77, p=0.003), MMF (OR=0.30, 95% CI 0.15 to 0.61, p<0.001) and biologics (OR=0.27, 95% CI 0.16 to 0.46, p<0.001) were associated with reduced anti-S1/S2 IgG positivity. Similar analyses demonstrated that prednisone ≥5 mg/day (OR=0.63, 95% CI 0.44 to 0.90, p=0.011), abatacept (OR=0.39, 95% CI 0.20 to 0.74, p=0.004), belimumab (OR=0.29, 95% CI 0.13 to 0.67, p=0.004) and rituximab (OR=0.11, 95% CI 0.04 to 0.30, p<0.001) were negatively associated with NAb positivity. Further evaluation of COVID-19 seronegative ARD at D210 demonstrated prominent increases in positivity rates at D240 for anti-S1/S2 IgG (80.5%) and NAb (59.1%) (p<0.0001). Conclusions We provide novel data on a robust response to the third dose of CoronaVac in patients with ARD, even in those with prevaccination COVID-19 seronegative status. Drugs implicated in reducing immunogenicity after the regular two-dose regimen were associated with non-responsiveness after the third dose, except for MTX. Trial registration number NCT04754698 .