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Immunogenicity of SARS-CoV-2 Vaccination Schedules Including a Booster Dose in Patients with Systemic Lupus Erythematosus: Data from a Prospective Multicenter Study

2025; Multidisciplinary Digital Publishing Institute; Volume: 13; Issue: 2 Linguagem: Inglês

10.3390/vaccines13020127

2076-393X

Natália Sarzi Sartori, Ketty Lysie Libardi Lira Machado, Samira Tatiyama Miyamoto, F. Z. Pretti, Maria da Penha Gomes Gouvea, Yasmin Gurtler Pinheiro de Oliveira, Vasco Silva, Filipe Faé, Ana Paula Neves Burian, K. Rosemarie Lallemand Tapia, Anna Carolina Simões Moulin, Luiza Lorenzoni Grillo, Paula dos Santos Athayde, Helena da Silva Corona, Sabrina de Souza Ramos, Flávia Maria Matos Melo Campos Peixoto, Priscila Dias Cardoso Ribeiro, Vanessa Oliveira Magalhães, Mariana Freitas de Aguiar, Erika Biegelmeyer, Cristiane Kayser, Alexandre Wagner Silva de Souza, Charlles Heldan de Moura Castro, Juliana Bühring, Sandra Lúcia Euzébio Ribeiro, Sérgio Henrique Oliveira dos Santos, Clara Pinheiro Martins, J. Rodrigues, Marcos Mavignier Sousa Dias, Bruna Guimarães Dutra, Camila Maria Paiva França Telles, Samuel Elias Basualto Dias, Rodrigo Poubel Vieira de Rezende, Kátia Lino, Rodrigo Cutrim Gaudio, Ana Karla Guedes de Melo, Valéria Bezerra da Silva, Vítor Alves Cruz, Jozélia Rêgo, Rejane Maria Rodrigues de Abreu Vieira, Adah Sophia Rodrigues Vieira, Adriana María Kakehasi, Anna Carolina Faria Moreira Gomes Tavares, Victória Dornelas Paz Carvalho, Renata Henriques de Azevedo, Valderílio Feijó Azevedo, Olindo Assis Martins-Filho, Vanessa Peruhype-Magalhães, Andrese Aline Gasparin, Vanessa Hax, Valéria Valim, Gilda Aparecida Ferreira, Andréa Teixeira-Carvalho, Edgard Torres dos Reis-Neto, Emília Inoue Sato, Marcelo M. Pinheiro, Viviane Angelina de Souza, Ricardo Machado Xavier, Gecilmara Salviato Pileggi, Odirlei André Monticielo,

Peripheral Neuropathies and Disorders

Objective: To evaluate the humoral response to and impact of SARS-CoV-2 vaccination in patients with systemic lupus erythematosus in a multicenter cohort design. Methods: Data for this analysis were obtained from the Study of Safety, Effectiveness and Duration of Immunity after Vaccination against SARS-CoV-2 in Patients with Immune-Mediated Inflammatory Diseases (SAFER), a prospective, multicenter, phase IV, real-world study conducted across different regions of Brazil from June/2021 to March/2024. Patients aged >18 years with systemic lupus erythematosus (SLE) who received any one of the SARS-CoV-2 vaccines approved by the Brazilian health regulatory agency (CoronaVac [inactivated SARS-CoV-2 vaccine], ChAdOx-1 [AstraZeneca], or BNT162b2 [Pfizer-BioNTech]) were included. Immunogenicity was assessed in pre- and post-vaccination blood samples, and patients were monitored in person and remotely for the occurrence and severity of COVID-19. Results: Two hundred and thirty-five patients with SLE who had completed their vaccination schedules (two doses + booster dose) were included in this study. Most patients were female (89.3%) and had low disease activity or were in remission (72.4%); the majority were also on some form of immunosuppressive therapy (58.1%). One hundred and sixteen patients received two doses of CoronaVac followed by one dose of BNT162b2 (Pfizer-BioNTech) vaccine, eighty-seven received two doses of ChAdOx1-S (AstraZeneca) followed by one dose of BNT162b2 (Pfizer-BioNTech) vaccine, and thirty-two received three doses of BNT162b2 (Pfizer-BioNTech) vaccine. Twenty-eight cases of COVID-19, none meeting criteria for severe COVID-19, were recorded in patients with respiratory symptoms after the second dose of a SARS-CoV-2 vaccine. Regarding immunogenicity, an increase in seroconversion rate was observed following consecutive vaccine doses, with no difference between vaccination schedules, reaching 97.57% seropositivity after a booster dose. The geometric mean IgG titers differed between the different vaccination schedules after the first and the second vaccine dose, being lowest for the CoronaVac-based schedule, but titers were similar after the administration of a booster dose. Conclusion: In patients with SLE, SARS-CoV-2 vaccines are immunogenic, inducing a robust humoral response. No severe outcomes associated with death or hospitalization were found in the evaluated patient sample. Complete vaccination schedules including a booster dose induced higher humoral responses than incomplete schedules, especially in patients initially immunized with an inactivated virus vaccine schedule and those with a suboptimal humoral response.