"Systematic assessment of the humoral response against SARS-CoV-2 in a French cohort of 283 patients with rheumatic diseases”

Abstract BackgroundTreatment with rituximab (RTX) blunts SARS-CoV-2 vaccination-induced humoral response. We sought to identify predictors of a positive immunogenic response to the BNT162b2 mRNA vaccine in patients with autoimmune inflammatory rheumatic diseases (AIIRD) treated with RTX (AIIRD-RTX).MethodsWe analyzed 108 AIIRD-RTX patients and 122 immunocompetent controls immunized with BNT162b2 mRNA vaccine participating in a multicenter vaccination study. Immunogenicity was defined by positive anti-SARS-CoV-2 S1/S2 IgG measured at 2 to 6 weeks after the second vaccine dose. We used a stepwise backward multiple logistic regression to identify predicting factors for a positive immunogenic response to vaccination and develop a predicting calculator, further validated in an independent cohort of AIIRD-RTX patients (n=48) immunized with the BNT162b2 mRNA vaccine.Results AIIRD-RTX patients who mounted a seropositive immunogenic response significantly differed from non-responders by lower number of RTX courses (median (range) 3 (1-10) vs 5 (1-15), p=0.007; lower cumulative RTX dose 6943.11±5975.74 vs 9780.95±7240.12 mg, p=0.033; higher IgG level prior to last RTX course (mean ± SD), 1189.78±576.28 vs. 884.33±302.31 mg/dL, p=0.002, and extended interval between RTX treatment and vaccination, 469.82±570.39 vs 162.08±160.12 days, p=0.0009, respectively. Patients with ANCA-associated vasculitis and inflammatory myositis had a low likelihood of a seropositive immunogenic response compared to patients with rheumatoid arthritis, odds ratio (OR) 0.209, 95% confidence interval (CI) 0.046-0.96, p=0.044 and OR 0.189, 95% CI 0.036-0.987, p=0.048, respectively. Based on these findings, we constructed a calculator predicting the probability of a seropositive immunogenic response following BNT162b2 mRNA vaccination which performed with 90.5% sensitivity, 59.3% specificity, 63.3% positive and 88.9% negative predictive values.ConclusionsThe predicting calculator might guide clinicians for optimal timing of BNT162b2 mRNA vaccination in AIIRD-RTX patients.

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Disease activity and humoral response in patients with inflammatory rheumatic diseases after two doses of the Pfizer mRNA vaccine against SARS-CoV-2

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-220503 ◽

2021 ◽

pp. annrheumdis-2021-220503

Author(s):

Yolanda Braun-Moscovici ◽

Marielle Kaplan ◽

Maya Braun ◽

Doron Markovits ◽

Samy Giryes ◽

...

Keyword(s):

Side Effects ◽

Rheumatic Diseases ◽

Messenger Rna ◽

Disease Duration ◽

Humoral Response ◽

Inflammatory Rheumatic Diseases ◽

Igg Antibodies ◽

Activity Assessment ◽

The Impact ◽

Immunomodulating Drugs

BackgroundThe registration trials of messenger RNA (mRNA) vaccines against SARS-CoV-2 did not address patients with inflammatory rheumatic diseases (IRD).ObjectiveTo assess the humoral response after two doses of mRNA vaccine against SARS-CoV-2, in patients with IRD treated with immunomodulating drugs and the impact on IRD activity.MethodsConsecutive patients treated at the rheumatology institute, who received their first SARS-CoV-2 (Pfizer) vaccine, were recruited to the study, at their routine visit. They were reassessed 4–6 weeks after receiving the second dose of vaccine, and blood samples were obtained for serology. IRD activity assessment and the vaccine side effects were documented during both visits. IgG antibodies (Abs) against SARS-CoV-2 were detected using the SARS-CoV-2 IgG II Quant (Abbott) assay.ResultsTwo hundred and sixty-four patients with stable disease, (mean(SD) age 57.6 (13.18) years, disease duration 11.06 (7.42) years), were recruited. The immunomodulatory therapy was not modified before or after the vaccination. After the second vaccination, 227 patients (86%) mounted IgG Ab against SARS-CoV-2 (mean (SD) 5830.8 (8937) AU/mL) and 37 patients (14%) did not, 22/37 were treated with B cell-depleting agents. The reported side effects of the vaccine were minor. The rheumatic disease remained stable in all patients.ConclusionsThe vast majority of patients with IRD developed a significant humoral response following the administration of the second dose of the Pfizer mRNA vaccine against SARS-CoV-2 virus. Only minor side effects were reported and no apparent impact on IRD activity was noted.

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Safety and Efficacy of Vaccination Against Influenza in Patients With Rheumatoid Arthritis

Clinical and Developmental Immunology ◽

10.1080/17402520600589613 ◽

2006 ◽

Vol 13 (2-4) ◽

pp. 349-351 ◽

Cited By ~ 16

Author(s):

Ori Elkayam

Keyword(s):

Rheumatoid Arthritis ◽

General Population ◽

Influenza Vaccination ◽

Rheumatic Diseases ◽

Humoral Response ◽

Safety And Efficacy ◽

Healthy Persons

Vaccination against influenza is currently recommended for patients with rheumatoid arthritis (RA). The safety and efficacy of vaccination in patients suffering from rheumatic diseases is still a matter of debate. This review summarizes the studies performed on the safety and immunogenicity of influenza vaccination in patients with RA as well as the rheumatic complications of the vaccine in otherwise healthy persons. Several trials have shown that the vaccine induces an adequate humoral response and does not induce clinical exacerbation of RA. Rheumatic complications (mainly vasculitis) following influenza vaccination in the general population are scarce.

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Data Do Not Justify Use of CAM in Rheumatic Diseases

Internal Medicine News ◽

10.1016/s1097-8690(10)70637-5 ◽

2010 ◽

Vol 43 (12) ◽

pp. 58

Author(s):

SARA FREEMAN

Keyword(s):

Rheumatic Diseases

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Reassessment of Suicide Attempters at Home, Shortly After Discharge from Hospital

Crisis ◽

10.1027/0227-5910/a000041 ◽

2010 ◽

Vol 31 (6) ◽

pp. 303-310 ◽

Cited By ~ 9

Author(s):

Bas Verwey ◽

Jeroen A. van Waarde ◽

Molla A. Bozdağ ◽

Iris van Rooij ◽

Edwin de Beurs ◽

...

Keyword(s):

Suicide Attempt ◽

General Hospital ◽

Hospital Environment ◽

Initial Assessment ◽

Suicide Attempters ◽

Systematic Assessment ◽

Suicide Intent ◽

Initial Hospital ◽

Discharge From Hospital ◽

At Home

Background: Assessment of suicide attempters in a general hospital may be influenced by the condition of the patient and the unfavorable circumstances of the hospital environment. Aims: To determine whether the results of a reassessment at home shortly after discharge from hospital differ from the initial assessment in the hospital. Methods: In this prospective study, systematic assessment of 52 suicide attempters in a general hospital was compared with reassessment at home, shortly after discharge. Results: Reassessments at home concerning suicide intent, motives for suicide attempt, and dimensions of psychopathology did not differ significantly from the initial hospital assessment. However, patients’ motives for the suicide attempt had changed to being less impulsive and more suicidal, worrying was significantly higher, and self-esteem was significantly lower. A third of the patients had forgotten their aftercare arrangements and most patients who initially felt no need for additional help had changed their mind at reassessment. Conclusions: Results from this group of suicide attempters suggest that a brief reassessment at home shortly after discharge from hospital should be considered.

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