JCI Insight (Jun 2022)

Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune-mediated inflammatory diseases

  • Roya M. Dayam,
  • Jaclyn C. Law,
  • Rogier L. Goetgebuer,
  • Gary Y.C. Chao,
  • Kento T. Abe,
  • Mitchell Sutton,
  • Naomi Finkelstein,
  • Joanne M. Stempak,
  • Daniel Pereira,
  • David Croitoru,
  • Lily Acheampong,
  • Saima Rizwan,
  • Klaudia Rymaszewski,
  • Raquel Milgrom,
  • Darshini Ganatra,
  • Nathalia V. Batista,
  • Melanie Girard,
  • Irene Lau,
  • Ryan Law,
  • Michelle W. Cheung,
  • Bhavisha Rathod,
  • Julia Kitaygorodsky,
  • Reuben Samson,
  • Queenie Hu,
  • W. Rod Hardy,
  • Nigil Haroon,
  • Robert D. Inman,
  • Vincent Piguet,
  • Vinod Chandran,
  • Mark S. Silverberg,
  • Anne-Claude Gingras,
  • Tania H. Watts

Journal volume & issue
Vol. 7, no. 11

Abstract

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BACKGROUND Limited information is available on the impact of immunosuppressants on COVID-19 vaccination in patients with immune-mediated inflammatory diseases (IMID).METHODS This observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, or psoriatic disease, with or without maintenance immunosuppressive therapies. Ab and T cell responses to SARS-CoV-2, including neutralization against SARS-CoV-2 variants, were determined before and after 1 and 2 vaccine doses.RESULTS We prospectively followed 150 subjects, 26 healthy controls, 9 patients with IMID on no treatment, 44 on anti-TNF, 16 on anti-TNF with methotrexate/azathioprine (MTX/AZA), 10 on anti–IL-23, 28 on anti–IL-12/23, 9 on anti–IL-17, and 8 on MTX/AZA. Ab and T cell responses to SARS-CoV-2 were detected in all participants, increasing from dose 1 to dose 2 and declining 3 months later, with greater attrition in patients with IMID compared with healthy controls. Ab levels and neutralization efficacy against variants of concern were substantially lower in anti-TNF–treated patients than in healthy controls and were undetectable against Omicron by 3 months after dose 2.CONCLUSIONS Our findings support the need for a third dose of the mRNA vaccine and for continued monitoring of immunity in these patient groups.FUNDING Funded by a donation from Juan and Stefania Speck and by Canadian Institutes of Health (CIHR)/COVID-Immunity Task Force (CITF) grants VR-1 172711 and VS1-175545 (to THW and ACG), CIHR FDN-143250 (to THW), GA2-177716 (to VC, ACG, and THW), and GA1-177703 (to ACG) and the CIHR rapid response network to SARS-CoV-2 variants, CoVaRR-Net (to ACG).

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