Background/Purpose: People with autoimmune diseases have worse outcomes if infected by SARS-CoV2. In particular, persons with rheumatoid arthritis (RA), have lower antibody responses to COVID-19 vaccine, are more commonly diagnosed with COVID-19 and have worse outcomes once infected. Some of these observations may in part be attributable to immune suppressive medications including steroids, Rituximab, Abatacept, Jak Inhibitors, and methotrexate. Less is known about T cell responses to COVID-19 vaccine, and whether these lower antibody responses are due to other factors including age, comorbidities, or pathogenic inflammation, is less clear. To address these questions, we evaluated T cell and B cell immunity in patients with RA on varying immune suppressive medications after receiving mRNA-based COVID-19 vaccines.

Methods: We evaluated serum samples for total anti-spike-specific IgG and anti-receptor binding domain (RBD)-specific IgG by magnetic bead-based assay before and 2, 8, 12, and 24 weeks after the second dose of COVID-19 mRNA vaccination. We examined SARS-CoV2 spike-specific T cell production of IFN-g and IL-2 by ELISPOT assay at the same time points in n=59 RA participants and n=88 non-autoimmune control participants.

Results: RA participants had lower serum antibody levels and lower IFN-g producing T cell frequencies 2 weeks after the second vaccine dose. This appeared to be the case across all medication treatment subgroups. Furthermore, while spike-specific IL-2 producing T cell frequency appeared comparable between control and RA participants, older age was negatively correlated with the number of IFN-g and IL-2 producing T cells and antibody titer in all paritipants combined.

Conclusion: These data indicate both lower COVID-19 mRNA vaccine-induced antibody levels and IFN-g producing T cell frequencies in the RA patient population compared to controls, and lower IFN-g and IL-2 producing T cell and antibody responses in older persons. Further study is needed to determine whether 3^rd or 4^th dosing of COVID-19 vaccine can overcome these impaired responses.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/covid-19-mrna-vaccine-induced-antibody-titers-and-ifn-g-responses-are-decreased-in-persons-with-rheumatoid-arthritis-and-older-age/