Medications Affect Antibody Responses to COVID-19 Vaccinations in Children with Autoimmune Diseases

Janna Shapiro¹, Florence Choi², Amy Xu³, Trang Duong⁴, Tania Watts¹, Anne-Claude Gingras⁵, Sasha Bernatsky⁶, Susanne Benseler⁷ and Rae Yeung⁸, ¹Department of Immunology, University of Toronto, Toronto, ON, Canada, ²Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada, ³The Hospital of Sick Children, Department of Paediatrics, University of Toronto, Division of Rheumatology; Cell Biology Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada, ⁴Cell Biology Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada, ⁵Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health; Department of Molecular Genetics, University of Toronto, Toronto, ON, ⁶Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Québec, Canada; Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada, ⁷Division of Rheumatology, Department of Paediatrics, The Alberta Children’s Hospital, Calgary, AB, ⁸The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Meeting: 2023 Pediatric Rheumatology Symposium

Keywords: Biologicals, COVID-19, Disease-Modifying Antirheumatic Drugs (Dmards), Pediatric rheumatology

Session Information

Date: Friday, March 31, 2023

Title: Posters: Clinical and Therapeutic II

Session Type: Poster Session B

Session Time: 5:00PM-6:00PM

Background/Purpose: To compare antibody responses to COVID-19 vaccines among children with autoimmune diseases taking different classes of immunosuppressants

Methods: A prospective observational study was conducted at Canadian paediatric centers. Children under the age of 18 with autoimmune disease (rheumatic and/or inflammatory bowel disease) were eligible for the study regardless of treatment. Antibodies against SARS-CoV-2 spike and receptor-binding domain were measured in either serum or dried blood spots collected after each COVID-19 vaccine dose. The kinetics and magnitude of antibody response following each vaccine dose were compared between treatment groups, using mixed-effects multivariable regression models. Participants who had been diagnosed with COVID-19 were excluded from the current analysis.

Results: From clinical and research registries, 2199 potential subjects were identified and 1941 were contacted by letter and telephone or during a clinic visit. From these, 239 individuals consented to participate in the study. For the current analyses, 116 participants contributed 57 samples post-COVID-19 vaccination dose 2, 59 samples post-dose 3, and 22 samples post-dose 4. It was found that anti-spike IgG responses were both reduced in magnitude and waned faster for participants treated with biologic DMARDs (disease modifying anti-rheumatic drugs) than for those who were treatment naive or receiving traditional DMARD therapy post-dose 2. For post-dose 3, IgG responses remained lower in the biologics group, but there were no clear differences in waning over time. After dose 4, no differences between the groups were observed. Among the biologics, anti-TNF therapies and rituximab had the greatest effect on IgG titers.

Conclusion: Antibody responses to COVID-19 vaccination in children with autoimmune diseases was lowest in individuals treated with biologics, particularly with anti-TNF agents and rituximab. Third and fourth vaccine doses are necessary to yield robust and durable antibody responses.

Disclosures: J. Shapiro: None; F. Choi: None; A. Xu: None; T. Duong: None; T. Watts: None; A. Gingras: None; S. Bernatsky: None; S. Benseler: None; R. Yeung: None.

To cite this abstract in AMA style:

Shapiro J, Choi F, Xu A, Duong T, Watts T, Gingras A, Bernatsky S, Benseler S, Yeung R. Medications Affect Antibody Responses to COVID-19 Vaccinations in Children with Autoimmune Diseases [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 4). https://acrabstracts.org/abstract/medications-affect-antibody-responses-to-covid-19-vaccinations-in-children-with-autoimmune-diseases/. Accessed .

« Back to 2023 Pediatric Rheumatology Symposium

ACR Meeting Abstracts - https://acrabstracts.org/abstract/medications-affect-antibody-responses-to-covid-19-vaccinations-in-children-with-autoimmune-diseases/