Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune-mediated inflammatory diseases
Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune-mediated inflammatory diseases
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DOI：
10.1172/jci.insight.159721
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发表时间：
2022-06-08
期刊：
影响因子：
8
通讯作者：
Watts, Tania H.
中科院分区：
文献类型：
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作者：
Dayam, Roya M.;Law, Jaclyn C.;Watts, Tania H.
背景关于免疫抑制剂对免疫介导的炎症性疾病（IMID）患者接种COVID-19疫苗的影响，现有信息有限。方法.这项观察性队列研究检查了SARS-CoV-2 mRNA疫苗在患有炎症性肠病、类风湿性关节炎、强直性脊柱炎或银屑病疾病的成人患者中的免疫原性，无论是否接受维持免疫抑制治疗。抗体和T细胞对SARS-CoV-2的反应，包括对SARS-CoV-2变异体的中和反应，在1和2次疫苗剂量之前和之后测定。结果我们前瞻性随访了150例受试者，26例健康对照，9例未接受治疗的IMID患者，44例接受抗TNF治疗，16例接受抗TNF联合甲氨蝶呤/硫唑嘌呤（MTX/AZA）治疗，10例接受抗IL-23治疗，28例接受抗IL-12/23治疗，9例接受抗IL-17治疗，8例接受MTX/AZA治疗。在所有参与者中检测到对SARS-CoV-2的抗体和T细胞反应，从剂量1到剂量2增加，3个月后下降，与健康对照组相比，IMID患者的磨损更大。抗TNF治疗的患者中的Ab水平和针对关注变体的中和效力显著低于健康对照，并且在第2次给药后3个月时无法检测到针对Omicron的抗体。结论.我们的研究结果支持需要第三剂mRNA疫苗，并继续监测这些患者群体的免疫力。
BACKGROUND. Limited information is available on the impact of immunosuppressants on COVID-19 vaccination in patients with immune-mediated inflammatory diseases (IMID). METHODS. This observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, or psoriatic disease, with or without maintenance immunosuppressive therapies. Ab and T cell responses to SARS-CoV-2, including neutralization against SARS-CoV-2 variants, were determined before and after 1 and 2 vaccine doses. RESULTS. We prospectively followed 150 subjects, 26 healthy controls, 9 patients with IMID on no treatment, 44 on anti-TNF, 16 on anti-TNF with methotrexate/azathioprine (MTX/AZA), 10 on anti-IL-23, 28 on anti-IL-12/23, 9 on anti-IL-17, and 8 on MTX/AZA. Ab and T cell responses to SARS-CoV-2 were detected in all participants, increasing from dose 1 to dose 2 and declining 3 months later, with greater attrition in patients with IMID compared with healthy controls. Ab levels and neutralization efficacy against variants of concern were substantially lower in anti-TNF-treated patients than in healthy controls and were undetectable against Omicron by 3 months after dose 2. CONCLUSIONS. Our findings support the need for a third dose of the mRNA vaccine and for continued monitoring of immunity in these patient groups.