DMARD combination/ monotherapy impairs the immunogenicity of inactivated SARS-CoV- 2 vaccine in rheumatoid arthritis

A recent study published in the Annals of Rheumatic Disease has concluded that the immunogenicity to CoronoVac is moderate in patients with RA receiving DMARDs. The study has noted that almost all the DMARD combinations impair the immunogenicity of inactivated SARS-CoV-2 vaccine in RA patients. Monotherapy with methotrexate, tofacitinib, abatacept and tocilizumab may also have a deleterious effect on immunogenicity.

The prospective, phase 4 study involved 260 RA patients and 104 controls without the disease. Investigations following vaccination demonstrated that RA patients had lower seroconversion (61.8% vs 94.2%, p<0.001) and neutralizing antibody positivity (45% vs 78.6%, p<0.001) as opposed to the controls. However, there was no influence of baseline disease activity on the immunogenicity (p>0.05).

The factors independently associated with decreased seroconversion were: older age, use of methotrexate or abatacept, and number of DMARDs. The factors negatively associated with the presence of neutralizing antibody positivity were age and prednisone use (>7.5 mg/day). The use of methotrexate/abatacept/tofacitinib/tocilizumab, either as monotherapy or in combination, was found to impair the immune responses in vaccinated subjects (p<0.05).

Sinovac-CoronaVac inactivated vaccine, which has demonstrated the efficacy of 83.5% against COVID-19, is one of the most widely used vaccines worldwide. The recent study provides novel evidence on the effect of different DMARDs, either as combinations or monotherapy, on the overall immunogenic response of the Sinovac-CoronaVac vaccine in patients with RA. These findings highlight the need for a comprehensive approach to enhancing the vaccine response in this subset of the population.

Reference: Medeiros-Ribeiro AC, Bonfiglioli KR, Domiciano DS, et al. Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis [published online ahead of print, 2022 Feb 8]. Ann Rheum Dis. 2022;annrheumdis-2021-221735.