Health
Third dose of mRNA COVID-19 vaccine in RA patients who responded poorly to previous doses
The majority of patients with rheumatoid arthritis (RA) who showed an inadequate response to anti-spiky protein 1 (S1) on the previous two doses of the COVID-19 vaccine had a third dose of the same species and the disease. Temporary discontinuation (DMARD) therapy of modified anti-rheumatic drugs Lancet rheumatology..
The authors of the report found the efficacy of a third dose of the mRNA-based anti-SARS-CoV-2 vaccine among RA patients who showed an inadequate serological response to the previous two doses of the vaccine. And evaluated the safety.
In the current analysis, all patients with RA who participated in the RECOVER trial and did not initiate an anti-S1 response within 12 weeks of the standard immune schedule were provided with a third vaccination.
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A total of 17 RA patients were eligible for a third dose of mRNA COVID-19 (New Coronavirus Infection) Vaccines from July 14th to August 25th, 2021. Of these participants, 16 agreed to temporarily discontinue DMARD therapy. Due to the previous recurrence of co-existing Crohn’s disease, only one patient continued to be treated with leflunomide and a tumor necrosis factor (TNF) inhibitor.
It was confirmed that anti-S1 antibody was low or absent before the third vaccination (median, 19.5 U / mL; range, 0.45-48 U / mL). Two weeks after participants received the third vaccination, a significant increase in anti-S1 antibody was reported (median 2500 U / mL, range, 798-2500 U / mL,). NS <.0001). Overall, 71% of participants (n = 12/17) showed the highest anti-S1 titer (assay upper limit, 2500 U / mL). Three patients had moderate anti-S1 titers.
In addition, the two participants who continued to receive treatment with prednisone 5 mg / day did not show a titer above the 133 U / mL threshold after the third vaccination, despite the suspension of DMARD dosing. It was. Overall, 35% of patients (n = 6/19) received prednisone at a median daily dose of 5 mg. Anti-S1 titers were significantly higher in participants who received and did not receive prednisone (median 2500 U / L and 515 U / mL, respectively. NS = .001).
After receiving the third vaccine, 35% (n = 6/17) of participants reported local pain and 53% (n = 9/17) of patients reported systemic vaccine-related side effects. rice field.
The limitations of this report were the small cohort size, short follow-up period, and the use of numerical anti-S1 response cutoffs.
The authors conclude that studies with a larger patient cohort allow analysis of the effects of different DMARD regimens on anti-S1 kinetics. [titers] Whether and how long does treatment need to be discontinued to optimize the vaccine-induced anti-S1 response? “
Disclosure: Some of the authors have declared partnerships with biotechnology, pharmaceutical, and / or device companies. See the original reference for a complete list of disclosures.
reference
Schmiedeberg K, Vuilleumier N, Pagano S, etc. Efficacy and tolerability of a third dose of the mRNA anti-SARS-CoV-2 vaccine in patients with rheumatoid arthritis who have no or minimal serological response to the previous two doses.. Lancet Ryumator.. Published online on October 26, 2021. doi: 10.1016 / S2665-9913 (21) 00328-3
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