Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/53150
Title: Strong response after fourth dose of mRNA COVID-19 vaccine in autoimmune rheumatic diseases patients with poor response to inactivated vaccine
Authors: AIKAWA, Nadia E.KUPA, Leonard V. K.SILVA, Clovis A.SAAD, Carla G. S.PASOTO, Sandra G.YUKI, Emily F. N.FUSCO, Solange R. G.SHINJO, Samuel K.ANDRADE, Danieli C. O.SAMPAIO-BARROS, Percival D.PEREIRA, Rosa M. R.CHASIN, Anna C. S.SHIMABUCO, Andrea Y.LUPPINO-ASSAD, Ana P.LEON, Elaine P.LOPES, Marta H.ANTONANGELO, LeilaMEDEIROS-RIBEIRO, Ana C.BONFA, Eloisa
Citation: RHEUMATOLOGY, v.62, n.1, p.480-485, 2022
Abstract: Objectives. To assess immunogenicity of a heterologous fourth dose of an mRNA (BNT162b2) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in autoimmune rheumatic diseases (ARD) patients with poor/non-response to inactivated vaccine (Sinovac-CoronaVac). Methods. A total of 164 ARD patients who were coronavirus disease 2019 (COVID-19) poor/non-responders (negative anti-SARS-CoV-2 S1/S2 IgG and/or neutralizing antibodies-NAb) to the third dose of Sinovac-CoronaVac received an additional heterologous dose of mRNA (BNT162b2) 3 months after last dose. IgG and NAb were evaluated before and after the fourth dose. Results. Significant increases were observed after the fourth dose in IgG (66.4 vs 95.1%, P < 0.001), NAb positivity (5.5 vs 83.5%, P < 0.001) and geometric mean titre (29.5 vs 215.8 AU/ml, P < 0.001), and 28 (17.1%) remained poor/non-responders. Patients with negative IgG after a fourth dose were more frequently under rituximab (P = 0 .001) . Negative NAb was associated with older age (P = 0.015), RA (P = 0 .002) , SSc (P = 0 .026) , LEF (P = 0 .01 6) and rituximab use (P = 0.007) . In multiple logistic regression analysis, prednisone dose >= 7.5 mg/day (OR =0.34; P = 0.047) , LEF (OR =0.32, P = 0.036) and rituximab use (OR =0.19, P = 0.022) were independently associated with negative NAb after the fourth vaccine dose. Conclusions. This is the largest study to provide evidence of a remarkable humoral response after the fourth dose of heterologous mRNA SARS-CoV-2 vaccination in ARD patients with poor/non-response to the third dose of an inactivated vaccine. We further identified that treatment, particularly rituximab and prednisone, impaired antibody response to this additional dose.
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Artigos e Materiais de Revistas Científicas - COVID-19
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