Humoral response following SARS-CoV-2 vaccination: not all immunosuppressants are created equal.
Humoral response following SARS-CoV-2 vaccination: not all immunosuppressants are created equal.
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DOI：
10.1016/s2665-9913(22)00066-2
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发表时间：
2022-05
期刊：
影响因子：
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通讯作者：
Paik JJ
中科院分区：
文献类型：
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作者：
Connolly CM;Paik JJ
已经确定，许多接受免疫抑制的患者对SARS-CoV-2疫苗接种的体液应答减弱。1，2事实上，免疫失调的人有更高的风险，SARS冠状病毒-2突破感染，尽管接种疫苗比免疫正常的人。3随着对免疫抑制人群中SARS-CoV-2疫苗反应的理解的发展，出现了一种药物等级，接受淋巴细胞清除治疗的患者，如利妥昔单抗和吗替麦考酚酯，免疫反应降低的风险最大。Luuk Wieske及其同事在The Lancet Rheumatology上的一项研究增加了现有的证据，即标准疫苗接种（定义为两剂ChAdOx 1 nCoV-19 [Oxford-AstraZeneca]，BNT 162 b2 [Pfizer-BioNtech]，CX-024414 [Moderna]或单剂Ad. 26. COV2。S [Janssen]）在接受抗CD 20治疗、1-磷酸鞘氨醇受体（S1 P）调节剂或霉酚酸酯联合治疗的免疫介导的炎症性疾病患者中是次优的。4在接受其他免疫抑制剂治疗的患者中观察到类似的血清转换率，尽管与对照组相比抗体滴度适度降低。鉴于这些患者的记忆反应保留的结果，作者得出结论，抗体滴度降低不太可能转化为短期保护的丧失。然而，我们认为，在缺乏临床结局数据的情况下，这一结论可能为时过早，更重要的是，研究已经证明了抗体滴度与突破性感染之间的相关性。5此外，最近的数据已经强调，需要显著更高的抗体浓度来克服由所关注的变体诱导的免疫逃避，6进一步
It is well established that many patients on immunosuppression have an attenuated humoral response to SARS-CoV-2 vaccination. 1, 2 Indeed, people with immune dysregulation have a higher risk of SARS-CoV-2 breakthrough infection despite vaccination than do immunocompetent people. 3 As understanding of the SARS-CoV-2 vaccine response among immunosuppressed populations evolves, a hierarchy among agents is emerging, with recipients of lymphocytedepleting therapies, such as rituximab and mycophenolate mofetil, at greatest risk of a reduced immune response. 1, 2A study in The Lancet Rheumatology by Luuk Wieske and colleagues adds to existing evidence that humoral responses after standard vaccination (defined as two-dose ChAdOx1 nCoV-19 [Oxford–AstraZeneca], BNT162b2 [Pfizer–BioNtech], CX-024414 [Moderna], or single-dose Ad. 26. COV2. S [Janssen]) are suboptimal among patients with immune-mediated inflammatory diseases treated with anti-CD20 therapy, sphingosine 1-phosphate receptor (S1P) modulator, or mycophenolate mofetil combination therapies. 4 Similar rates of seroconversion were observed among patients treated with other immunosuppressants, although antibody titres were moderately reduced compared with controls. Given findings of a preserved recall response in these patients, the authors conclude that reduced antibody titres are unlikely to translate to loss of short-term protection. However, we believe that this conclusion might be premature in the absence of clinical outcome data, and more importantly, studies have demonstrated the correlation between antibody titres and breakthrough infections. 5 Moreover, recent data have highlighted that significantly higher antibody concentrations are required to overcome immune evasion induced by variants of concern, 6 further