Background/Purpose: The COVID-19 virus has caused significant morbidity and mortality, despite introduction of the COVID vaccine. Immunocompromised patients have been shown to have reduced response to the COVID vaccine compared to healthy individuals. There is currently limited data on the responsiveness of pediatric systemic lupus erythematosus (SLE) patients to the COVID vaccine.

Methods: To evaluate the effectiveness of the COVID vaccine in generating an antibody response in immunosuppressed pediatric SLE patients, retrospective data were collected for SLE patients 1-21 years of age seen at Children’s National Hospital and who have been fully vaccinated against COVID-19. Fully vaccinated was defined as having received at least two doses of the Pfizer or Moderna vaccine or having received one dose of the Johnson & Johnson vaccine. Patients were included if they were on immunosuppression at the time of vaccination.

Results: Ten patients met inclusion criteria for the study, and all tested positive for SARS-CoV-2 spike IgG. The average age of the patients was 15.5 ± 3.6 years old. Eight patients were female, and 7 patients identified as Black/African American. One patient had a documented history of COVID infection, whereas the other patients had no prior reported history of COVID infection. All patients had lupus nephritis. At the time of vaccination, 7 were receiving prednisone (1 patient on high dose, 6 patients on steroid wean, average dose 0.39 ± 0.68 mg/kg/d), and 6 were receiving mycophenolate mofetil (average dose 1193 ± 258 mg/m²/d). In addition, 2 patients received belimumab, 1 received rituximab, 1 received tacrolimus, 1 received cyclophosphamide, and 2 received methotrexate. One of the patients receiving methotrexate had active arthritis and was also receiving adalimumab. Two patients (22%) received 2 doses of the Moderna vaccine, 5 patients (56%) received 2 doses of the Pfizer vaccine, and 2 patients (22%) received 3 doses of the Pfizer vaccine. One patient received dose 1 of the Pfizer vaccine prior to receiving immunosuppression. IgG levels were measured at a mean of 91.7 ± 55.4 days after the last COVID vaccine. The mean±SD IgG level for patients who received all vaccine doses while on immunosuppression was 283.5 ± 200.7 AU/mL. Patients who received 2 doses of the Pfizer vaccine had slightly lower IgG titers (231 ± 155.1 AU/mL) compared to those who received 2 doses of the Moderna vaccine (297 ± 145 AU/mL). None of the 10 patients had a documented COVID infection post-vaccination. In addition, 3 patients who were diagnosed with SLE and started on immunosuppression post-vaccination also had COVID IgG titers drawn; all had a positive titer at a mean±SD level of 318.3 ± 418.2 AU/mL.

Conclusion: In a small population of pediatric SLE patients on immunosuppression, all patients mounted an appreciable antibody response to the vaccine as demonstrated by positive SARS-CoV-2 IgG titers. Their titer levels were similar to those of a smaller cohort of SLE patients who were not on immunosuppression at the time of vaccination. These results differ from reduced responses seen in transplant and adult SLE patients. Further studies are needed with a larger cohort of patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-the-covid-19-vaccine-in-pediatric-systemic-lupus-erythematosus-patients/