Safety and efficacy of third dose SARS COV -2 VACCINATION in patients on immunosuppressive therapy

A recent study published in Arthritis and Rheumatology reported the safety and the serological response of the third SARS-CoV-2 vaccine dose in patients on immunosuppressive therapy.  However, when compared to healthy controls, immune-mediated inflammatory diseases (IMID) patients demonstrated attenuated response to routine vaccination.

The prospective observational study carried out by a group of Norway researchers included 1647 adult patients on immunosuppressive medication for rheumatoid arthritis, spondylarthritis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis, as well as 1114 healthy controls who received routine two-dose SARS-CoV-2 immunization. Standard SARS-CoV-2 immunization was found to be effective in 1505 (91%) patients and 1096 (98%) healthy controls (P <0.001).

The median anti-receptor-binding domain (RBD) was decreased in patients compared to healthy controls. Lower age and vaccination with mRNA1273 were both predictive of response and patients who received tumour necrosis factor inhibitor combination treatment, Janus kinase inhibitors, or abatacept had the lowest rate of responses. Moreover, 129 (84 percent) of the 153 patients who received a third dose after a poor response became responders. The safety profile of the patients and controls was found to be similar.

Syversen and co-authors concluded that the third vaccine dosage given to patients who had a limited reaction was shown to be safe and effective in most cases. These findings will help healthcare systems design and implement immunization programs for IMID patients on immunosuppressive medications. Moreover, it will assist in clinical decision-making about revaccinations and medication tailoring to keep this vulnerable population protected against deadly COVID-19 infections.

Reference: Syversen SW, Jyssum I, Tveter AT, et al. Immunogenicity and Safety of Standard and Third Dose SARS-CoV-2 Vaccination in Patients on Immunosuppressive Therapy [published online ahead of print, 2022 May 4]. Arthritis Rheumatol. 2022;10.1002/art.42153.