Journal Article

Impact of Immunomodulatory Therapy on COVID-19 Vaccine Response in Patients with Autoimmune Inflammatory Rheumatic Diseases

Mu, Rong, Lai, Yi Wye, Xu, Dan, Wei, Chang, Thong, Bernard Yu-Hor, Ng, Joel Jia Wei, Feng, Shuo, Xu, Chuanhui, Yap, Ruth Xian Lynn

2024

Overview

Coronavirus disease 2019 (COVID-19) vaccination is essential for patients with autoimmune inflammatory rheumatic diseases (AIIRD) to reduce the risk of morbidity and mortality associated with serious COVID-19 infection. With endemicity, waning of vaccine- and infection-acquired immunity, and development of SARS-CoV-2 variants, the need for additional doses of vaccines against serious illness in high-risk immunocompromised persons remains imperative. This review examines how immunomodulatory therapies affect vaccine-induced immune response in patients with AIIRD. Glucocorticoids, methotrexate, azathioprine, calcineurin inhibitors, mycophenolate mofetil, tumor necrosis factor inhibitors, and abatacept have been shown to variably attenuate both humoral and cellular immune responses to vaccination. Janus kinase inhibitors reduce humoral immune response. In contrast, sulfasalazine, leflunomide, belimumab, interleukin (IL)-17, IL-12/23, IL-6, and IL-1 inhibitors appear favorable, with mild or no impact on vaccine response. Although rituximab is known to profoundly diminish humoral immune response, cellular immunity is relatively preserved. Administering a third and subsequent vaccine dose or temporally coordinating the dosing of immunomodulatory drugs may improve vaccine effectiveness. Further research is needed to personalise vaccination strategies for AIIRD patients, considering their specific immunomodulatory treatments.

• Publisher: MDPI AG,MDPI
• Subject: Adenosine / Antibodies / autoimmune inflammatory rheumatic disease / Azathioprine / Calcineurin inhibitors / Cell-mediated immunity / Comorbidity / Coronaviruses / COVID-19 / COVID-19 vaccines / Diagnosis / Dihydrofolate reductase / Dosage / Drug dosages / Glucocorticoids / Humoral immunity / Immune response / Immune response (cell-mediated) / Immune response (humoral) / Immune system / Immunity / immunogenicity / Immunomodulation / Immunosuppressive agents / Inhibitors / Interleukins / Janus kinase / Kinases / Leflunomide / Lymphocytes / Methotrexate / Morbidity / mRNA vaccines / Mycophenolate mofetil / Mycophenolic acid / Observational studies / Pandemics / Patients / Prevention / Review / Rheumatic diseases / Rheumatoid arthritis / Risk factors / Rituximab / Severe acute respiratory syndrome coronavirus 2 / Sulfasalazine / vaccination / Vaccine efficacy / Vaccines / Vectors (Biology) / Viral diseases