Effects of antineoplastic and immunomodulating agents on postvaccination SARS-CoV-2 breakthrough infections, antibody response, and serological cytokine profile.
Effects of antineoplastic and immunomodulating agents on postvaccination SARS-CoV-2 breakthrough infections, antibody response, and serological cytokine profile.
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DOI：
10.1136/jitc-2023-008233
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发表时间：
2024-01-31
影响因子：
10.9
通讯作者：
Pandey AC
中科院分区：
文献类型：
--
作者：
New J;Cham J;Smith L;Puglisi L;Huynh T;Kurian S;Bagsic S;Fielding R;Hong L;Reddy P;Eum KS;Martin A;Barrick B;Marsh C;Quigley M;Nicholson LJ;Pandey AC
Despite immunization, patients on antineoplastic and immunomodulating agents have a heightened risk of COVID-19 infection. However, accurately attributing this risk to specific medications remains challenging. An observational cohort study from December 11, 2020 to September 22, 2022, within a large healthcare system in San Diego, California, USA was designed to identify medications associated with greatest risk of postimmunization SARS-CoV-2 infection. Adults prescribed WHO Anatomical Therapeutic Chemical (ATC) classified antineoplastic and immunomodulating medications were matched (by age, sex, race, and number of immunizations) with control patients not prescribed these medications yielding a population of 26 724 patients for analysis. From this population, 218 blood samples were collected from an enrolled subset to assess serological response and cytokine profile in relation to immunization. Prescription of WHO ATC classified antineoplastic and immunomodulatory agents was associated with elevated postimmunization SARS-CoV-2 infection risk (HR 1.50, 95% CI 1.38 to 1.63). While multiple immunization doses demonstrated a decreased association with postimmunization SARS-CoV-2 infection risk, antineoplastic and immunomodulatory treated patients with four doses remained at heightened risk (HR 1.23, 95% CI 1.06 to 1.43). Risk variation was identified among medication subclasses, with PD-1/PD-L1 inhibiting monoclonal antibodies, calcineurin inhibitors, and CD20 monoclonal antibody inhibitors identified to associate with increased risk of postimmunization SARS-CoV-2 infection. Antineoplastic and immunomodulatory treated patients also displayed a reduced IgG antibody response to SARS-CoV-2 epitopes alongside a unique serum cytokine profile. Antineoplastic and immunomodulating medications associate with an elevated risk of postimmunization SARS-CoV-2 infection in a drug-specific manner. This comprehensive, unbiased analysis of all WHO ATC classified antineoplastic and immunomodulating medications identifies medications associated with greatest risk. These findings are crucial in guiding and refining vaccination strategies for patients prescribed these treatments, ensuring optimized protection for this susceptible population in future COVID-19 variant surges and potentially for other RNA immunization targets.
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影响因子：
27.4
作者：
Mrak, Daniel;Tobudic, Selma;Bonelli, Michael
通讯作者：
Bonelli, Michael
影响因子：
3.7
作者：
Ikegami S;Benirschke RC;Fakhrai-Rad H;Motamedi MH;Hockett R;David S;Lee HK;Kang J;Gniadek TJ
通讯作者：
Gniadek TJ
影响因子：
4
作者：
Stoll, Sharon;Desai, Shree;Levit, Elle
通讯作者：
Levit, Elle
影响因子：
5.5
作者：
Spagnolo F;Boutros A;Croce E;Cecchi F;Arecco L;Tanda E;Pronzato P;Lambertini M
通讯作者：
Lambertini M
影响因子：
28.4
作者：
Haggenburg, Sabine;Hofsink, Quincy;Nijhof, Inger S.
通讯作者：
Nijhof, Inger S.