Infectious Disease
One in five immunosuppressed patients lack any response after three COVID vaccine doses
November 06, 2023
2 min read
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Key takeaways:
- More than 20% of immunocompromised patients show no detectable antibodies after three or more COVID-19 vaccine doses.
- However, this proportion improves with sequential booster doses.
Approximately 20% of patients with solid organ transplants, rare autoimmune rheumatic diseases or lymphoid cancers fail to mount a response to three or more COVID-19 vaccine doses, according to data published in The Lancet Rheumatology.
However, the researchers additionally concluded that the proportion of patients who are non-responders decreases with sequential booster doses.
Data derived from Pearce FA, et al. Lancet Rheum. 2023;doi:10.1016/S2665-9913(23)00160-1.
“We know from previous research that people who have a weakened immune system were more likely to catch COVID-19,” Michelle Willicombe, MD, of the Imperial College London, said in a press release about the study released by the University of Southampton, in the United Kingdom. “They were also more likely to need to go into hospital for treatment or die from COVID-19.”
To investigate the prevalence of SARS-CoV-2 antibodies in patients with documented immunocompromising conditions, Willicombe and colleagues conducted a cross-sectional study using data from U.K.-based national disease registries. The study, called the Mass Evaluation of Lateral Flow Immunoassays for the Detection of SARS-CoV-2 Antibody Responses in Immunosuppressed People — or MELODY — evaluated antibody levels in patients with solid organ transplant, autoimmune and rheumatic diseases, and lymphoid malignancies identified in the registries.
Potential participants were invited by mail to participate in the study between Dec. 7, 2021, and June 26, 2022. These individuals registered through an online platform and completed a survey that included questions on socioeconomic status, COVID-19 vaccination status, COVID-19 infection history, clinical diagnoses and immunosuppressive therapies. Following enrollment, patients were supplied a lateral flow immunoassay test and were instructed to record their results on the online platform.
The analysis included 23,036 patients who provided serological data for the study. Of those patients, 9,927 had received solid-organ transplants, 6,516 had rare autoimmune rheumatic diseases and 6,953 reported lymphoid malignancies. Out of this pool, 6,583 patients had received three doses of a SARS-CoV-2 vaccine, 14,234 had received four doses and 2,219 had received five or more doses.
According to the researchers, IgG anti-spike antibodies were undetectable in 23.3% of the patients who underwent solid organ transplants, 14.1% of those with autoimmune rheumatic diseases and 20.7% of patients who reported lymphoid malignancies. Across every group, factors associated with seropositivity included younger age, more vaccine doses and a previous COVID-19 infection.
The researchers additionally found that the lowest chances of seropositivity were recorded among those with solid organ transplants receiving combination therapy with an anti-proliferative agent, a calcineurin inhibitor and steroids, as well as in those with rare autoimmune rheumatic diseases or lymphoid malignancies receiving anti-CD20 drugs.
“Given the influence of confounding characteristics, we show serological testing of populations who are immunosuppressed could provide personalized risk stratification not achieved by clinical characteristics alone,” Willicombe and colleagues wrote. “We also provide insight into how this stratification might be achieved in the community, and how sero-testing this population could identify those individuals who might maximally benefit from pre-exposure prophylaxis.
“Furthermore, our data also support the continued uptake of boosters in patients who are immunosuppressed, with seroconversion rates increasing with sequential vaccine doses,” they added. “As a key challenge is to improve the vaccine-induced immunity of individuals who are immunosuppressed, our data might also provide insight into further bespoke booster schedules for this population, which could be guided by community antibody surveillance.”
References:
Research helps to identify immunosuppressed people least likely to have COVID-19 antibodies. https://www.eurekalert.org/news-releases/998601. Aug. 15, 2023. Accessed Aug. 21, 2023.
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Sources/Disclosures
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Disclosures:
Pearce reports financial disclosures with Vifor Pharma and is also a member of the Strategy and Integration Group at Health Data Research UK. Please see the full study for a complete list of each authors’ disclosures.
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