Full vaccination course is necessary for efficient response

People with inflammatory arthritis may have impaired response to the first dose but excellent final responses to mRNA vaccines.

INTRODUCTION
COVID-19 is the disease caused by a new type of coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It was declared a pandemic by the World Health Organization on 11 March 2020. COVID-19 has forced people to change their behaviours to try to limit the spread of infection.
Rheumatoid arthritis and spondyloarthritis are chronic inflammatory diseases that affect a person’s joints or spine, respectively, and may cause pain and disability. Some people with inflammatory arthritis are treated with drugs that affect their immune system (often called immunomodulators). These include conventional synthetic disease-modifying antirheumatic drugs (often shortened to csDMARDs) such as methotrexate, and biologic or targeted synthetic therapies (bDMARDs and tsDMARDs). However, some of these drugs might mean people are more at risk for more severe COVID-19 infection. Some of these therapies might also interfere with how vaccines work. It is therefore important to develop vaccinations strategies for these groups of people.

WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to find out how people with rheumatoid arthritis or spondylarthritis treated with immunomodulatory drugs respond to mRNA vaccination (BioNtech/Pfizer or Moderna) against SARS-CoV-2 compared to healthy controls not taking any immunomodulatory drugs.

WHO WAS STUDIED?
The study looked at 53 people with rheumatoid arthritis, 46 with spondylarthritis, and 169 healthy participants without rheumatic disease. Everyone taking part agreed to have their antibody levels analysed after their first and second dose of the vaccine.

HOW WAS THE STUDY CONDUCTED?
This was an observational, real-world study. The people with rheumatoid arthritis or spondylarthritis were all treated at one clinic in Vienna. Everyone received two doses of an mRNA vaccine against COVID-19. The authors used blood samples to see how well people responded to the vaccines. This was done by measuring the antibodies against two key parts of the virus: the receptor-binding domain and the nucleocapsid protein. These two measures allowed the researchers to distinguish between an immune response to the vaccine, and an immune response to infection with SARS-CoV-2. The results were compared to a control group of people who did not have rheumatic disease, and were not taking immunomodulatory therapies.

WHAT WAS THE MAIN FINDING?
The authors found that people taking immunomodulatory drugs had a weaker response after the first dose of vaccine compared to healthy controls. However, after the second dose of the vaccine, the majority of people with rheumatoid arthritis or spondylarthritis showed adequate antibody development, comparable to the controls. Only people taking a combination of two immunomodulatory drugs had reduced antibody levels compared to healthy controls.

ARE THESE FINDINGS NEW?
Yes, this report adds new information about how people taking immunomodulatory drugs for inflammatory
arthritis develop adequate antibody response to vaccination against COVID-19.

WHAT ARE THE LIMITATIONS OF THIS STUDY?
One limitation is that the study looked at a small number of people. The impact of specific therapies will have to be determined in future studies.

WHAT DO THE AUTHORS PLAN TO DO WITH THIS INFORMATION?
Studies like this form the basis for recommendations for vaccination strategies in people taking immunomodulatory drugs. The authors plan to take follow-up measurements to see how long the immune response lasts in the people who took part.

WHAT DOES THIS MEAN FOR ME?
If you have rheumatoid arthritis or spondylarthritis you should get vaccinated against SARS-CoV-2. These vaccines will work despite your underlying disease. However, some people – especially those using a combination of immunomodulatory drugs – might have a lower vaccination response.
Protect yourself from COVID-19 by following the advice of the government in your country. The best protection is getting vaccinated, but you should also wash your hands regularly, and avoid touching your face. Where recommended, follow social distancing rules, and use protective masks. Maintaining good ventilation may also help stop the virus spreading.

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Date prepared: February 2022
Summary based on research article published on: 29 November 2021
From: Simader E, et al. Importance of the second SARS-CoV-2 vaccination dose for achieving serological response in patients with rheumatoid arthritis and seronegative spondyloarthritis. Ann Rheum Dis 2022;81:416–421. doi:10.1136/annrheumdis-2021-221347

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