Immune Response to SARS-CoV-2 Third Vaccine in Patients With Rheumatoid Arthritis Who Had No Seroconversion After Primary 2-Dose Regimen With Inactivated or Vector-Based Vaccines

ISNARDI, CAROLINA A.; CRUCES, LEONEL; ALFARO, MARÍA AGUSTINA; GIORGIS, PAMELA; REYES GÓMEZ, CAMILA R.; ABARZA, VIRGINIA CARRIZO; REIMUNDES, CECILIA; QUIROGA, MARÍA FLORENCIA; DE LA VEGA, MARÍA CELINA; MAID, PABLO; LANDI, MARGARITA; MONTORO, CLAUDIA CALLE; GÓMEZ VARA, ANDREA B.; CRESPO ROCHA, MARÍA G; ROSEMFFET, MARCOS G.; PERANDONES, MIGUEL; TURK, GABRIELA; QUINTANA, ROSANA; PIFANO, MARINA; CITERA, GUSTAVO; CERDA, OSVALDO L.; SCHNEEBERGER, EMILCE E.; ROLDÁN, BRIAN M.; EZQUER, ROBERTO ALEJANDRO; DE LOS ÁNGELES CORREA, MÁRIA; PELLET, SANTIAGO CATALAN; LONGUEIRA, YESICA; LAUFER, NATALIA; KREPLAK, NICOLÁS; PONS-ESTEL, GUILLERMO J.

JOURNAL OF RHEUMATOLOGY

J RHEUMATOL PUBL CO

Año: 2022 vol. 49 p. 1385 - 1389

0315-162X

OBJECTIVE: The aim of this study was to assess the immune response after a third dose of SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA) with undetectable antibody titers after the primary regimen of 2 doses. METHODS: Patients with RA with no seroconversion after 2 doses of SARS-CoV-2 vaccine and who received a third dose of either an mRNA or vector-based vaccine were included. Anti-SARS-CoV-2 IgG antibodies, neutralizing activity, and T cell responses were assessed after the third dose. RESULTS: A total of 21 nonresponder patients were included. At the time of vaccination, 29% were receiving glucocorticoids and 85% biologic disease-modifying antirheumatic drugs (including 6 taking abatacept [ABA] and 4 taking rituximab [RTX]). The majority (95%) received the BNT162b2 vaccine and only one of them received the ChAdOx1 nCoV-19 vaccine. After the third dose, 91% of the patients presented detectable anti-SARS-CoV-2 IgG and 76% showed neutralizing activity. Compared to other treatments, ABA and RTX were associated with the absence of neutralizing activity in 4 out of 5 (80%) patients and lower titers of neutralizing antibodies (median 3, IQR 0-20 vs 8, IQR 4-128; P = 0.20). Specific T cell response was detected in 41% of all patients after the second dose, increasing to 71% after the third dose. The use of ABA was associated with a lower frequency of T cell response (33% vs 87%, P = 0.03). CONCLUSION: In this RA cohort, 91% of patients who failed to seroconvert after 2 doses of SARS-CoV-2 vaccine presented detectable anti-SARS-CoV-2 IgG after a third dose. The use of ABA was associated with a lower frequency of specific T cell response.