A multi-ethnic cohort study demonstrates that 29% of patients with lupus had an inadequate response to the COVID-19 vaccines. Interestingly, patients taking anti-malarials showed an almost 12-times improved response. Overall disease activity did not change after vaccination. “Many of us in the rheumatology community have been working on addressing the question of whether certain immunosuppressive medications affect the response to the new COVID-19 vaccines,” said Dr. Peter Izmirly (New York University Grossman School of Medicine). “Our group has previously shown that after natural infection with SARS-CoV-2, most lupus patients developed and maintained a serologic response to the virus.” The current study explored the serological response and the development of SLE flares among a group of 90 patients compared with 20 healthy controls after COVID-19 vaccination.1 “We decided to limit our study to only patients with SLE to assess both the medications and disease effect on the response to the vaccine and to assess any change in disease activity post-vaccination,” said Dr. Izmirly. In general, patients with SLE had lower mean antibody titers after vaccination compared with healthy patients. The researchers found that 26 patients with SLE (29%) developed an IgG antibody response to the SARS-CoV-2 spike receptor-binding domain, which fell below the lowest response obtained for controls. In bivariate analysis, lower vaccine response was associated with the use of prednisone, immunosuppressants, or mycophenolate mofetil. In contrast, taking anti-malarial drugs was associated with a more positive response to the vaccine. Patients who received the Johnson & Johnson vaccine showed worse responses. Disease activity was assessed by the hybrid SLE disease activity index (SLEDAI) and flares by the SELENA/SLEDAI flare index. Only 11% of patients experienced disease flares after vaccination, 1% of which were severe. “The data from our group and others have shown that overall disease activity did not change after vaccination,” said Dr. Izmirly. “Our study also showed that severe flares were rare. Most flares were mild to moderate and manageable. Certain medications or combinations of medications could affect the efficacy of the vaccines. While minimal protective levels remain unknown, these data suggest protocol development is needed to assess the efficacy of booster vaccination.

  1. Izmirly PM, et al. Evaluation of Immune Response and Disease Status in SLE Patients Following SARS-CoV-2 Vaccination. Abstract 1420. ACR Convergence 2021, 3-10. November.

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