Background/Purpose: Patients with Systemic Lupus Erythematosus (SLE) often receive immunosuppressive treatment for many years, resulting in higher risk of infections, including COVID-19, and infections may trigger disease flares. Patients with SLE show reduced immunogenicity against influenza and pneumococcal vaccination, however the immune response depends on immunosuppressive therapy and disease activity. Our aim was to investigate the immune response during a 24-month follow-up period in patients with SLE following COVID-19 vaccination with a two-dose regimen.

Methods: Patients with SLE (≥18 years of age) in the Region of Southern Denmark were invited to participate in the study. Blood samples were drawn approximately 3 weeks after the first vaccination and 4 and 8 weeks after the second vaccination. SLEDAI-score and SLICC damage were assessed between vaccinations and 8 weeks after the second vaccination. Patients’ hospital records were reviewed for clinical information and treatment data. Anti-SARS-CoV-2 Spike IgG was determined using Abbotts SARS-CoV-2 IgG II Quant. Resulting concentrations (AU/ml were converted to IU/ml using a lot-specific factor calibrated against the “First WHO International Standard for anti-SARS-CoV-2 immunoglobulin (20/136)). A positive cut off for Anti-SARS-CoV-2 Spike IgG was set at >8.7 IU/ml. Nucleocapsid IgG was determined using Abbotts SARS-CoV-2 IgG.

Results: A total of 128 patients with SLE were included in the study. We report the preliminary results of antibody response to the SARS-CoV-2 spike antigen of 90 patients who have completed the two-dose vaccine regimen in this ONGOING STUDY (Table 1). Of these, 55 (49.5%) of the participants had blood samples drawn for IgG antibodies after the first vaccination and seropositive SARS-CoV-2 spike IgG antibody titers were detected in 31 (56.4%) with an overall mean of 92.7 IU/ml (±327.6).
The response rate was increased to 93.3% (84) four weeks after the second dose with an overall mean of 1601.3 IU/ml (±1752.6). Of participants with a positive response 81 (96.4%) recieved the BNT162b2 vaccine, 2(2.4%) recieved the AZD1222 vaccine and 1(1.2%) recieved the mRNA-1273 vaccine.
The median SLEDAI score was 2 (IQR: 0-6) and SCLICC damage score was 1 (IQR: 0-2) between vaccinations, and there was no significant difference between responders and non-responders (Mann-Whitney, P=0.2113 and P=0.0623, respectively). All participants were negative for SARS-CoV-2 nucleocapsid IgG, suggesting that none of the patients had COVID-19 prior to vaccination.

Conclusion: Patients with SLE had a good antibody response after COVID-19 vaccination, without secondary flare of disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/antibody-response-in-patients-with-systemic-lupus-erythematosus-after-a-two-dose-regimen-with-sars-cov-2-vaccines-preliminary-results/