Frontiers in Immunology (Jul 2023)

SARS-CoV-2 infection risk is higher in vaccinated patients with inflammatory autoimmune diseases or liver transplantation treated with mycophenolate due to an impaired antiviral immune response: results of the extended follow up of the RIVALSA prospective cohort

  • Manuela Rizzi,
  • Stelvio Tonello,
  • Stelvio Tonello,
  • Cristiana Brinno,
  • Erika Zecca,
  • Erika Zecca,
  • Erika Zecca,
  • Erica Matino,
  • Erica Matino,
  • Erica Matino,
  • Micol Cittone,
  • Eleonora Rizzi,
  • Eleonora Rizzi,
  • Eleonora Rizzi,
  • Giuseppe Francesco Casciaro,
  • Giuseppe Francesco Casciaro,
  • Giuseppe Francesco Casciaro,
  • Davide D’Onghia,
  • Donato Colangelo,
  • Rosalba Minisini,
  • Mattia Bellan,
  • Mattia Bellan,
  • Mattia Bellan,
  • Mattia Bellan,
  • Mattia Bellan,
  • Luigi Mario Castello,
  • Luigi Mario Castello,
  • Annalisa Chiocchetti,
  • Annalisa Chiocchetti,
  • Mario Pirisi,
  • Mario Pirisi,
  • Mario Pirisi,
  • Mario Pirisi,
  • Mario Pirisi,
  • Cristina Rigamonti,
  • Cristina Rigamonti,
  • Daniele Lilleri,
  • Federica Zavaglio,
  • Federica Bergami,
  • Daniele Sola,
  • Pier Paolo Sainaghi,
  • Pier Paolo Sainaghi,
  • Pier Paolo Sainaghi,
  • Pier Paolo Sainaghi,
  • Pier Paolo Sainaghi

DOI
https://doi.org/10.3389/fimmu.2023.1185278
Journal volume & issue
Vol. 14

Abstract

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BackgroundA relevant proportion of immunocompromised patients did not reach a detectable seroconversion after a full primary vaccination cycle against SARS-CoV-2. The effect of different immunosuppressants and the potential risks for SARS-CoV-2 infection in these subjects is largely unknown.MethodsPatients from the Rivalsa prospective, observational cohort study with planned anti SARS-CoV-2 third dose mRNA vaccination between October and December 2021 were asked to participate to this follow-up study. Patients were asked about eventual confirmed positivity to SARS-CoV-2 infection within 6 months from the third dose and to undergo a blood draw to evaluate seroconversion status after the additional vaccine shot.Results19 out of 114 patients taking part in the survey developed a confirmed SARS-CoV-2 infection; we identified mycophenolate treatment as an independent predictor of an increased risk of infection even after the third vaccine dose (OR: 5.20, 95% CI: 1.70-20.00, p=0.0053). This result is in agreement with the in vitro evidence that MMF impairs both B and T lymphocytes driven immune responses (reduction both in memory B cells producing anti-spike antibodies and in proliferating CD4+ and CD8+ T cells).ConclusionsImmunocompromised patients need an additional vaccine administration to reach a detectable seroconversion, thus fostering a more personalized approach to their clinical management. Moreover, patients undergoing mycophenolate treatment show a specific increased infection risk, with respect to other immunosuppressants thus supporting a closer monitoring of their health status.

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