Frontiers in Immunology (Nov 2024)
Immunosuppressants in dermatology on vaccine immunogenicity: a prospective cohort study of pemphigus patients in the pandemic
- Kun-Lin Lu,
- Kun-Lin Lu,
- Kun-Lin Lu,
- Kun-Lin Lu,
- Kun-Lin Lu,
- Hua-En Lee,
- Hua-En Lee,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Chun-Bing Chen,
- Rosaline Chung-Yee Hui,
- Rosaline Chung-Yee Hui,
- Ya-Ching Chang,
- Ya-Ching Chang,
- Chun-Wei Lu,
- Chun-Wei Lu,
- Chun-Wei Lu,
- Chun-Wei Lu,
- Chun-Wei Lu,
- Chuang-Wei Wang,
- Chuang-Wei Wang,
- Chuang-Wei Wang,
- Chuang-Wei Wang,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung,
- Wen-Hung Chung
Affiliations
- Kun-Lin Lu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Kun-Lin Lu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Kun-Lin Lu
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
- Kun-Lin Lu
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
- Kun-Lin Lu
- Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Hua-En Lee
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Hua-En Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Chun-Bing Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chun-Bing Chen
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
- Chun-Bing Chen
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
- Chun-Bing Chen
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chun-Bing Chen
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chun-Bing Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chun-Bing Chen
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
- Chun-Bing Chen
- 0School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
- Rosaline Chung-Yee Hui
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Rosaline Chung-Yee Hui
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Ya-Ching Chang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Ya-Ching Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chun-Wei Lu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Chun-Wei Lu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chun-Wei Lu
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
- Chun-Wei Lu
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chun-Wei Lu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chuang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Chuang-Wei Wang
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
- Chuang-Wei Wang
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
- Chuang-Wei Wang
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou, Taiwan
- Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Keelung, Taiwan
- Wen-Hung Chung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Wen-Hung Chung
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
- Wen-Hung Chung
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
- Wen-Hung Chung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou, Taiwan
- Wen-Hung Chung
- Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
- Wen-Hung Chung
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
- Wen-Hung Chung
- 1Allergology Consortium, Xiamen Chang Gung Hospital, Xiamen, China
- Wen-Hung Chung
- 2Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- Wen-Hung Chung
- 3Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Wen-Hung Chung
- 4Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
- DOI
- https://doi.org/10.3389/fimmu.2024.1506962
- Journal volume & issue
-
Vol. 15
Abstract
IntroductionBoth cellular and humoral responses are important for vaccine protection, but recommendations on immunosuppressants in dermatology are largely based on pre-pandemic experiences. This study aimed to investigate the impacts of immunosuppressants on humoral and cellular immunogenicity to COVID-19 vaccinations in pemphigus patients.MethodsSARS-CoV-2-naïve pemphigus patients and age-, and sex-matched healthy controls were recruited from multiple tertiary medical centers during 2021-2023. Anti-spike protein-related T-cell responses, antibody titers, and high-parameter cell analysis of the peripheral blood were utilized to investigate the inhibitory effects of immunosuppressants, including rituximab and azathioprine.ResultsA total of 32 patients and 120 healthy controls were enrolled. COVID-19 vaccinations spaced at least six months after the last rituximab infusion did not cause a significant difference in anti-viral T-cell or antibody responses between rituximab-naïve and rituximab-treated patients. All pemphigus patients demonstrated improved antibody responses after the third vaccination and none of them suffered from severe COVID-19 illness. Intriguingly, we found that daily dosages of 100 mg or more of azathioprine were linked to significantly decreased anti-viral T-cell responses induced by the vaccination (mean of fold change [SD]; higher azathioprine dosage = 0.70 [0.61] folds vs. lower azathioprine dosage = 2.11 [1.03] folds; p = 0.044).ConclusionExcept for a subset of patients with unrecovered B-cell deficiency, rituximab infusion with proper scheduling of vaccination preserved better anti-viral T-cell responses and did not lead to hindered antibody responses in pemphigus patients. All pemphigus patients benefited from receiving the third booster regardless of B-cell status.
Keywords
- vaccine immunogenicity
- anti-viral humoral immunity
- anti-viral t-cell response
- rituximab
- azathioprine
- pemphigus vulgaris
