Journal Article

Humoral response to mRNA vaccines against SARS-CoV-2 in patients with humoral immunodeficiency disease

Helbling, Arthur, Sidler, Daniel, Staehelin, Cornelia, Horn, Michael P., Rauch, Andri, Moor, Matthias B., Gschwend, Anna, Jörg, Lukas, Bitzenhofer, Michaela, Suter-Riniker, Franziska

2022

Overview

Although mRNA-based vaccines against SARS-CoV-2 induce a robust immune response and prevent infections and hospitalizations, there are limited data on the antibody response in individuals with humoral immunodeficiency. The aim of this study was to evaluate the humoral immune response after two vaccine doses with BNT162b2 or mRNA-1273 in patients with humoral immunodeficiency disease. This cross-sectional study assessed 39 individuals with hypogammaglobulinemia under immunoglobulin replacement therapy. IgG anti-SARS-CoV-2 spike protein antibodies (anti-S) were measured 4 weeks to 4 months after two doses of an mRNA vaccine against SARS-CoV-2. The proportion of patients, who developed a humoral immune response to the spike protein were evaluated and compared to 19 healthy controls. After vaccination with two vaccine doses, 26/39 patients (66.7%) with humoral immunodeficiency disease and all healthy controls developed anti-S. In subjects with baseline IgG <3 g/l, only 1/5 (20%) showed a humoral immune response. 10 out of 26 with CVID (38.5%) and 7/9 under immunosuppressive drugs (77.8%) developed no immune response (13 subjects with no response) compared to 0/19 in healthy controls. Subgroup analysis in patients without immunosuppressive drugs revealed lower anti-S in patients with moderate to severe humoral immunodeficiency disease: baseline IgG <3 g/l: 12.0 AU/ml (95%CI 12.0-125.0), baseline IgG 3-5 g/l: 99.9 AU/ml (95%CI 14.4-400.0), baseline IgG >5 g/l: 151.5 AU/ml (95%CI 109.0-400.0), healthy controls 250.0 AU/ml (95%CI 209.0-358.0), p = 0.007. In most patients with mild to moderate humoral immunodeficiency we found only slightly lower anti-S antibodies compared with healthy controls after two vaccine doses with BNT162b2 and mRNA-1273. However, in patients with a decreased baseline IgG below 3 g/l and/or under immunosuppressive drugs, we found severely impaired humoral immune responses.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Analysis / Antibodies / Antibodies, Viral / Antibody response / Biology and Life Sciences / BNT162 Vaccine / Common variable immunodeficiency / Coronaviruses / COVID-19 / COVID-19 - prevention & control / COVID-19 Vaccines / Cross-Sectional Studies / Disease control / Disease susceptibility / Drug dosages / Drugs / Evaluation / Humans / Hypogammaglobulinemia / Immune response / Immune response (humoral) / Immune system / Immunity, Humoral / Immunodeficiency / Immunoglobulin G / Immunoglobulins / Immunosuppressive agents / Influenza / Medicine and Health Sciences / Messenger RNA / mRNA / mRNA Vaccines / Patients / Proteins / SARS-CoV-2 / Severe acute respiratory syndrome / Severe acute respiratory syndrome coronavirus 2 / Spike protein / Statistical analysis / Subgroups / Vaccination / Vaccines / Vaccines, Synthetic