Humoral protection to SARS-CoV2 declines faster in patients on TNF alpha blocking therapies.

Ulf M Geisen, Melike Sümbül, Florian Tran, Dennis K Berner, Hayley M Reid, Lena Vullriede, Maria Ciripoi, Ann C Longardt, Paula Hoff, Peter J Morrison, Verena E Schneider, Rainald Zeuner, Jan H Schirmer, Andrea Steinbach, Susanna Nikolaus, S Gerdes, Stefan Schreiber, Petra Bacher, Bimba F Hoyer
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Journal title abbreviated:
RMD Open
Journal title long:
RMD open
<h4>Background</h4>The persistence of the SARS-CoV2 pandemic, partly due to the appearance of highly infectious variants, has made booster vaccinations necessary for vulnerable groups. Questions remain as to which cohorts require SARS-CoV2 boosters. However, there is a critical lack of data on the dynamics of vaccine responses in patients with chronic inflammatory diseases (CID) undergoing immunosuppressive/disease modifying anti-rheumatic (DMARD) treatment. Here, we present the first data regarding the decline of the vaccine-induced humoral immune responses in patients with CID.<h4>Methods</h4>23 patients with CID were monitored clinically and for anti-spike IgG and IgA levels, neutralization efficacy and antigen-specific CD4+ T cell responses over the first 6 months after SARS-CoV2 vaccination. 24 healthy individuals were included as controls.<h4>Results</h4>While anti-spike IgG-levels declined in CID patients and healthy controls, patients receiving anti-TNF treatment showed significantly greater declines at 6 months post second vaccination in IgG and especially neutralizing antibodies. IgA levels were generally lower in CID patients, particularly during anti-TNF therapy. No differences in SARS-CoV2 spike-specific CD4+ T-cell frequencies were detected.<h4>Conclusion</h4>Although the long-term efficacy of SARS-CoV2 vaccination in CID patients undergoing disease-modifying therapy is still not known, the pronounced declines in humoral responses towards SARS-CoV2 6 months after mRNA vaccination in the context of TNF blockade should be considered when formulating booster regimens. These patients should be considered for early booster vaccinations.