Booster Vaccine Encouraged Among Patients on Immunosuppressive Therapy

Studies found vaccine boosters to improve overall humoral immune responses among adults with immune-mediated inflammatory diseases on immunosuppressive therapy. Furthermore, longer intervals between booster doses resulted in stronger humoral response to hybrid immunity, the findings suggested.

“Hybrid immunity gives a very substantial humoral immune response in patients with immune-mediated inflammatory diseases on immunosuppressive therapy, implying that additional vaccine doses can be postponed in patients with hybrid immunity,” the research published in the Lancet Rheumatology.

The prospective observational Norwegian study included 914 adults with immune-mediated inflammatory diseases such as rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, Crohn's disease, or ulcerative colitis, on immunosuppressive therapy. The patients were divided into 3 categories: vaccine group where the patients received all 4 doses of SARS-CoV-2 vaccine, hybrid group where the patients received 3 vaccine doses followed by COVID-19, and the control group where the healthy patients received 3 vaccine doses.

The researchers obtained the patient database from the Division of Rheumatology at Diakonhjemmet Hospital, Oslo, and the Department of Gastroenterology at Akershus University Hospital, Lørenskog, between November 2021 and April 2022. The end points of the study were the antibody levels after 2-4 weeks of vaccination or COVID-19 infection.

The patients in the vaccine group (n=536) had higher anti-RBD antibody concentrations following the fourth vaccine dose (median 6192 BAU/ml [IQR 2878–11 243]) than after third dose (median 5087 BAU/ml [1250–9081]; p< 0·0001), but lower antibody concentrations than the control group after third dose (median 7595 BAU/ml [5916–12 001]; p< 0·0001). The antibody concentrations were significantly higher in the hybrid group (23 548 BAU/ml [IQR 11 440–35 935])

The antibody concentration levels post-booster shots significantly improved humoral immune responses among the large cohort of patients with immune-mediated inflammatory diseases on immunosuppressive therapy. “Moreover, this study showed superiority of hybrid immunity resulting in a stronger immune response than infection-naïve patients with four vaccine doses,” the study concluded.

Patients and controls had a comparable safety profile.

—Priyam Vora

Reference:
Tveter A, Jyssum I, Sexton J et al. Four SARS-CoV-2 vaccine doses or hybrid immunity in patients on immunosuppressive therapies: a Norwegian cohort study. The Lancet Rheum. 2022; 5(1): E36-E46. DOI: https://doi.org/10.1016/S2665-9913(22)00330-7