The findings of a nationwide retrospective analysis published in Rheumatology reported that patients with an autoimmune rheumatic disease (ARDs) who received a fourth dosage of the BNT162b2 COVID-19 vaccine seem to be better protected than patients who received three doses.
Dr. Amir Bieber and co-researchers evaluated the effects of the fourth dose of COVID-19 vaccination using BNT162b2 COVID-19 Â in patients with ARDs. They found that the fourth dose was linked to a lower risk of COVID-19 infection than the controls. Out of 43,748 recruited patients with ARDs, 27,766 and 15,982 belonged to the control and fourth vaccination groups, respectively. About 25% of the control group and 11% of the fourth dosage group contracted COVID-19, respectively (P <0.001). Regardless of the baseline characteristics or medical treatment, patients who received the fourth dose had a reduced risk of COVID-19 infection than the overall cohort (HR 0.54) and throughout every subgroup, except for rituximab. A similar association was noted for the risk of COVID-19-related hospitalization (HR 0.36) and COVID-19-related death (HR 0.41).
A 2022 study also reported the safety of the BNTb262 vaccine in patients with autoimmune inflammatory rheumatic diseases. A considerably lower level of BNT162b2-induced immunogenicity was noted in patients who received treatment with glucocorticoids, rituximab, mycophenolate mofetil, and abatacept. After immunization, patients had significantly lower seropositivity rates and S1/S2 IgG levels than controls (86% vs. 100%, P <0.0001). Older age and therapy with glucocorticoids, rituximab, mycophenolate mofetil, and abatacept were identified as the risk factors for decreased immunogenicity. Â The experts found that patients with autoimmune inflammatory rheumatic diseases did not exhibit any post-vaccination symptoms of COVID-19, while the control group only experienced one minor instance. They also reported that postvaccination disease activity remained steady in most patients.
Thus, patients with ARD who received the COVID-19 vaccine had a lower risk of infection, associated hospitalizations, and death. Further research is required to evaluate the long-term efficacy and safety of vaccination, the durability of the humoral vaccination response, and T-cell-mediated immunity in patients with a poor humoral response.
References
- Bieber A, Brikman S, Novack L, Abuhasira R, Fawaz A, Abu-Shakra M, et al. Fourth dose of BNT162b2 vaccine for patients with autoimmune rheumatic diseases in a nationwide setting. Rheumatology. 2023 Feb 10:kead064.
- Furer V, Eviatar T, Zisman D, Peleg H, Paran D, Levartovsky D, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: a multicentre study. Annals of the rheumatic diseases. 2021 Oct 1;80(10):1330-8.