Journal Article

Immunogenicity of SARS-CoV-2 Vaccination Schedules Including a Booster Dose in Patients with Systemic Lupus Erythematosus: Data from a Prospective Multicenter Study

Kayser, Cristiane, Martins-Filho, Olindo Assis, Vieira, Adah Sophia Rodrigues, Valim, Valéria, Cruz, Vitor Alves, Xavier, Ricardo Machado, Melo, Ana Karla Guedes de, Magalhães, Vanessa de Oliveira, Grillo, Luiza Lorenzoni, Sartori, Natália Sarzi, Azevedo, Renata Henriques de, Ferreira, Gilda Aparecida, Athayde, Paula dos Santos, da Silva, Vanezia Gonçalves, Pretti, Flávia Zon, Tapia, Karina Rosemarie Lallemand, de Moura Castro, Charlles Heldan, Miyamoto, Samira Tatiyama, Sousa Dias, Marcos Mavignier, Biegelmeyer, Erika, Carvalho, Victória Dornelas Paz, Ribeiro, Priscila Dias Cardoso, de Souza, Alexandre Wagner Silva, Sato, Emília Inoue, Monticielo, Odirlei André, de Oliveira, Yasmin Gurtler Pinheiro, Pileggi, Gecilmara Salviato, Burian, Ana Paula Neves, Gaudio, Rodrigo Cutrim, Kakehasi, Adriana Maria, Baptista, Katia Lino, Gouveia, Maria da Penha Gomes, Oliveira dos Santos, Sérgio Henrique, Ramos, Sabrina de Souza, Telles, Camila Maria Paiva França, Pinheiro, Marcelo de Medeiros, Peruhype-Magalhães, Vanessa, de Aguiar, Mariana Freitas, Gasparin, Andrese Aline, V

2025

Overview

Objective: To evaluate the humoral response to and impact of SARS-CoV-2 vaccination in patients with systemic lupus erythematosus in a multicenter cohort design. Methods: Data for this analysis were obtained from the Study of Safety, Effectiveness and Duration of Immunity after Vaccination against SARS-CoV-2 in Patients with Immune-Mediated Inflammatory Diseases (SAFER), a prospective, multicenter, phase IV, real-world study conducted across different regions of Brazil from June/2021 to March/2024. Patients aged >18 years with systemic lupus erythematosus (SLE) who received any one of the SARS-CoV-2 vaccines approved by the Brazilian health regulatory agency (CoronaVac [inactivated SARS-CoV-2 vaccine], ChAdOx-1 [AstraZeneca], or BNT162b2 [Pfizer-BioNTech]) were included. Immunogenicity was assessed in pre- and post-vaccination blood samples, and patients were monitored in person and remotely for the occurrence and severity of COVID-19. Results: Two hundred and thirty-five patients with SLE who had completed their vaccination schedules (two doses + booster dose) were included in this study. Most patients were female (89.3%) and had low disease activity or were in remission (72.4%); the majority were also on some form of immunosuppressive therapy (58.1%). One hundred and sixteen patients received two doses of CoronaVac followed by one dose of BNT162b2 (Pfizer-BioNTech) vaccine, eighty-seven received two doses of ChAdOx1-S (AstraZeneca) followed by one dose of BNT162b2 (Pfizer-BioNTech) vaccine, and thirty-two received three doses of BNT162b2 (Pfizer-BioNTech) vaccine. Twenty-eight cases of COVID-19, none meeting criteria for severe COVID-19, were recorded in patients with respiratory symptoms after the second dose of a SARS-CoV-2 vaccine. Regarding immunogenicity, an increase in seroconversion rate was observed following consecutive vaccine doses, with no difference between vaccination schedules, reaching 97.57% seropositivity after a booster dose. The geometric mean IgG titers differed between the different vaccination schedules after the first and the second vaccine dose, being lowest for the CoronaVac-based schedule, but titers were similar after the administration of a booster dose. Conclusion: In patients with SLE, SARS-CoV-2 vaccines are immunogenic, inducing a robust humoral response. No severe outcomes associated with death or hospitalization were found in the evaluated patient sample. Complete vaccination schedules including a booster dose induced higher humoral responses than incomplete schedules, especially in patients initially immunized with an inactivated virus vaccine schedule and those with a suboptimal humoral response.

• Publisher: MDPI AG,MDPI
• Subject: Analysis / Autoimmune diseases / Care and treatment / Chronic conditions / COVID-19 / COVID-19 vaccines / Deactivation / Drug dosages / Immune response / Immune response (humoral) / Immunity (Disease) / Immunization / Immunogenicity / Immunoglobulin G / Immunosuppressive agents / Infections / Inflammatory diseases / Lupus / Remission / Remission (Medicine) / Research ethics / Rheumatic diseases / Rheumatology / SARS-CoV-2 vaccines / Schedules / Seroconversion / Severe acute respiratory syndrome coronavirus 2 / Steroids / Systemic lupus erythematosus / Vaccines / Viral diseases