Background/Purpose: The mRNA-based SARS-CoV-2 vaccine has shown efficacy in large vaccine trials. However, patients on immunosuppressive therapies including those with rheumatic disease (RD) were excluded. Recent studies have examined the immunogenicity of SARS-CoV-2 vaccination in immunocompromised patients. We thus conducted a systematic review and meta-analysis on the humoral immune response of SARS-CoV-2 vaccination in patients with rheumatic disease.

Methods: We systematically searched Pubmed/Medline, Scopus, and MedRxiv from January 1, 2021- May 30, 2021 to identify eligible studies that examined the immunogenicity of SARS-CoV-2 vaccination in RD patients. Included studies provided information on proportion of RD patients who developed an immune response following the second dose of the vaccine. Immune response was defined as development of IgG antibodies to SARS-CoV-2 S anti-receptor binding domain (RBD) or neutralizing antibodies with cutoffs established by manufacturer. Information on RD type and immunosuppressant use was also obtained from each study. Meta-Analysis was performed using Comprehensive Meta-Analysis.

Results: Our meta-analysis included eight studies (3 observational studies, 5 case-control studies) which was comprised of 1482 RD patients. The pooled response rate following vaccination against SARS-CoV-2 was 0.88 (95% CI 0.75-0.94). Compared to non-RD patients, RD patients had significantly decreased response to SARS-CoV-2 vaccination (RR 0.88, 95% 0.84-0.93). Patients on rituximab (37%), mycophenolate (70.8%), prednisone (86.6%), and methotrexate (91.9%) showed lower vaccine response. On the other hand, patients on TNF (100%), JAK (96.3%), and IL-17 inhibitors (92.9%) showed higher vaccine response.

Conclusion: In this systematic review and meta-analysis, majority of RD patients developed an immune response following second dose of SARS-CoV-2 vaccine. However, the vaccine response rate was significantly lower in RD patients compared to controls. This is likely driven by certain immunosuppressants particularly B-cell depleting therapy which can hamper the humoral immune response. Future studies need to examine the use and timing of these immunosuppressants prior to SARS-CoV-2 vaccination.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-sars-cov-2-vaccine-in-patients-with-rheumatic-diseases-a-systematic-review-and-meta-analysis/