Immunogenicity of SARS-CoV-2 Vaccine in Dialysis
Immunogenicity of SARS-CoV-2 Vaccine in Dialysis
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DOI：
10.1681/asn.2021040432
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发表时间：
2021-11-01
影响因子：
13.6
通讯作者：
Weiner, Daniel E.
中科院分区：
文献类型：
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作者：
Lacson, Eduardo, Jr.;Argyropoulos, Christos P.;Weiner, Daniel E.
接受维持性透析的患者是一个高风险的免疫受损人群，25%的COVID-19死亡率在mRNA疫苗的临床试验中未被代表。方法所有接受维持性透析的患者，接受两剂SARS-CoV-2 mRNA疫苗，包括第二次给药后14天，如电子健康记录中记录的，截至2021年3月18日。应答是基于针对SARS-CoV-2刺突抗原S1亚基受体结合域的Ig-G水平（血清阳性？结果在8个州30个诊所的186例透析患者中，检测了23例（23 U/L）患者的血凝素水平。接种两剂疫苗后8天，有165例（88.7%）应答者，最大滴度为70%。BNT 162 b2/Pfizer（148/168，88.1%）和mRNA-1273/Moderna（17/18，94.4%）之间无显著差异，P=0.42。所有38名有COVID-19病史的患者均为应答者，最大滴度为97%。在非COVID-19患者中，148人中有127人（85.8%）为应答者，BNT 162 b2/Pfizer之间相当（113/133）和mRNA-1273/Moderna（14/15）疫苗结论大多数维持性透析患者在接受两剂BNT 162 b2/Pfizer或mRNA-1273/Moderna疫苗后应答，这表明抗刺突抗体的短期发展是好的，这给了大多数易受感染的患者希望，一旦接种疫苗，将受到保护，免受COVID-19的影响。需要进行长期评估，以确定抗体滴度的持久性，以及是否需要加强剂量。需要进一步的研究来评估没有血清学应答的患者的方法，包括额外剂量或替代方案的益处。
Background Patients receiving maintenance dialysis represent a high-risk, immune-compromised population with 15%?25% COVID-19 mortality rate who were unrepresented in clinical trials of mRNA vaccines.Methods All patients receiving maintenance dialysis who received two doses of SARS-CoV-2 mRNA vaccines with antibody test results drawn ?14 days after the second dose, as documented in the electronic health record through March 18, 2021, were included. Response was on the basis of levels of Ig-G against the receptor binding domain of the S1 subunit of SARS-CoV-2 spike-antigen (seropositive ?2 U/L) using an FDA-approved semiquantitative chemiluminescent assay (ADVIA Centaur XP/XPT COV2G).Results Among 186 patients on dialysis from 30 clinics in eight states tested 23?8 days after receiving two vaccine doses, there were 165 (88.7%) responders with 70% at maximum titer. There was no significant difference between BNT162b2/Pfizer (148 out of 168, 88.1%) and mRNA-1273/Moderna (17 out of 18, 94.4%), P=0.42. All 38 patients with COVID-19 history were responders, with 97% at maximum titer. Among patients without COVID-19, 127 out of 148 (85.8%) were responders, comparable between BNT162b2/Pfizer (113 out of 133) and mRNA-1273/Moderna (14 out of 15) vaccines (85.0% versus 93.3%, P=0.38).Conclusions Most patients receiving maintenance dialysis responded after two doses of BNT162b2/Pfizer or mRNA-1273/Moderna vaccine, suggesting the short-term development of antispike antibody is good, giving hope that most of these patients who are vulnerable, once immunized, will be protected from COVID-19. Longer-term evaluation is needed to determine antibody titer durability and if booster dose(s) are warranted. Further research to evaluate the approach to patients without a serologic response is needed, including benefits of additional dose(s) or administration of alternate options.