Nearly One Third of Lupus Patients Show Low Responses to COVID-19 Vaccines

Overall, patients with lupus had a lower mean titer of post-vaccine antibodies compared to healthy patients.

Nearly 30 percent of lupus patients with had a low response to the new COVID-19 vaccines, finds  research presented at ACR Convergence, the American College of Rheumatology’s annual meeting.

Since Phase III clinical trials of COVID-19 vaccines excluded people who take immunosuppressant or immune-modifying drugs within the last six months before enrollment, there is little data on how the new shots work in people with lupus. Because they fear a disease flare, some people with rheumatic diseases like lupus have been hesitant about getting vaccinated. This new study looked at seroreactivity and lupus disease flares after COVID-19 vaccination in a broad group of 90 lupus patients compared to 20 healthy controls.

“Many of us in the rheumatology community have been working on addressing the question of whether certain immunosuppressive medications affect the response to the new COVID-19 vaccines,” says Peter M. Izmirly, MD, a rheumatologist at NYU Langone Health in New York City and the study’s co-author, in a news release. “Our group has previously shown that after natural infection with SARS-CoV-2 (coronavirus), most lupus patients did develop and maintain a serologic response to the virus. We decided to limit our study to only patients with SLE to assess both the medications and disease effect on the response to the vaccine, and to assess any change in disease activity post-vaccination.”

All patients in the study received a complete COVID-19 vaccine schedule. Their IgG seroreactivity to the SARS-CoV-2 Spike receptor binding domain was measured by two different tests to evaluate B-cell response to the vaccine, and their IFN-gamma production was measured to determine their T-cell response. Their lupus disease activity and any lupus disease flares were also measured.

Overall, patients with lupus had a lower mean titer of post-vaccine antibodies compared to healthy patients. Researchers found that 26 lupus patients generated IgG antibody responses to the SARS-CoV-2 Spike receptor binding domain that fell below the lowest response levels for healthy patients.

Researchers found that the patients medications mattered: lower vaccine response was associated with use of prednisone in combination with at least one immunosuppressant drug, use of prednisone alone, use of a combination of two immunosuppressants, or use of mycophenolate mofetil or mycophenolic acid. People with lupus who had a normal anti-dsDNA antibody level before vaccination had a lower response, as well as those who received the Jansen/Johnson & Johnson brand vaccine.