Patients with systemic lupus erythematosus (SLE) who received a “boost” dose of the SARS-CoV-2 vaccine after being fully vaccinated were about as likely to develop a subsequent “breakthrough” COVID-19 infection, a new study shows half of .
The findings should reassure the more than 200,000 Americans with SLE, a condition in which the body’s immune system mistakenly attacks its own healthy tissues, especially joints and skin, the researchers said. Immunosuppressive drugs, such as steroids, needed to control disease symptoms put them at higher risk for infections, including SARS-CoV-2.
Led by researchers at NYU Grossman School of Medicine, the new study tracked the health of 163 fully vaccinated men and women treated for SLE at a New York City-affiliated hospital. The researchers aimed to see who had contracted the virus for at least six months, as more than half were taking at least one immunosuppressive drug for their SLE. All had received some combination of vaccines made by Pfizer, Moderna or Johnson & Johnson until June 2021, but only 125 had received a third or booster dose.
published in journals Lancet Rheumatology Online July 12, the study showed that at the end of the monitoring period (April 24, 2022), 44 vaccinated SLE patients developed breakthrough infections, two of whom required hospitalization (but all survived the infection).
Among the breakthrough infections, 28 of 125 (22%) received a booster immunization, while 16 of 38 (42%) did not receive a booster immunization. Notably, according to investigators, most of the breakthrough infections (42 of 44) occurred after December 2, 2021, when the first case of the highly contagious omicron variant was detected in the city.
Another important study finding was in 57 study participants who agreed to have their blood antibody levels checked, once after a full vaccination and once after receiving a booster immunization.
The researchers found that even in those immunosuppressed patients who did not respond to the first round of vaccination, antibody levels rose immediately after the booster shot. Previous studies have shown that many initially vaccinated patients with rheumatic disease, including SLE, have low levels of antibodies who are taking immunosuppressive drugs, raising concerns about the spread of COVID-19 over time. 19 fears of weakened immunity.
However, the findings suggest that those with higher levels of antibodies, which are needed to block the SARS-Cov-2 “spike” protein and prevent the virus from infecting human cells, did not have higher levels of antibodies to the spike protein than those with lower levels of antibodies to the spike protein. No more protection from breakthrough infections. .
Nonetheless, the researchers say their previous work has shown that elevated antibody levels in fully vaccinated lupus patients reinforce a key measure of long-term immunity, which may help explain the lack of severe disease in those with breakthrough infections reason.
“Our findings provide clinical confirmation for people with systemic lupus erythematosus that the vaccine is highly effective in preventing severe COVID-19, despite their increased risk of contracting the disease,” said the study’s co-principal investigator and rheumatologist Home says Amit Saxena, MD, MS.
“The COVID-19 vaccine booster, or third dose, provides additional, double protection against breakthrough infection,” said Saxena, assistant professor in NYU Langone Health’s Department of Medicine. “Even in cases of SARS-CoV-2 infection, in full Among vaccinated SLE patients, the vast majority of cases are mild.”
“Our study also shows that despite immunosuppression, most patients with systemic lupus erythematosus respond well after full vaccination and booster immunizations,” said study co-senior investigator and rheumatologist Peter Izmir said Peter Izmirly. Izmirly is an associate professor in the Department of Medicine at NYU Langone Health.
However, the researchers caution that further monitoring of patients is needed to determine if there is any antibody “cutoff” level below which SLE patients are more susceptible to SARS-CoV-2 infection.
During the first wave of the pandemic in spring 2020, NYU Langone’s SLE patients were more than twice as likely to be hospitalized as unaffected patients, despite the same mortality rate, the researchers noted.
Funding support for this research was provided by the National Institutes of Health (P50AR07059) and Bloomberg Philanthropies COVID-19 Response.
In addition to Saxena and Izmirly, the other NYU Langone researchers involved in this study are co-principal investigator Alexis Engel, BS; Study co-investigators: Brittany Banbury, MD; Gadir Hassan, MD; Nicola Frey Zell, BS; Devyn Zaminski, BS; Maramason, BA; Rebecca Haberman, MD; Jose Shell, MD; Gary Ho, MD; Jammie Law, MD; Paula Rackoff, MD; Chung-E Tseng, MD; H. Michael Belmont, MD; Robert Clancy, MD; and Joint Senior Investigator Jill Buyon, MD.
Saxena has received consulting fees from AstraZeneca, GlaxoSmithKline, Bristol-Myers Squibb, Eli Lilly and Kezar Life Sciences, makers of drugs used to treat SLE. Izmirly has served on an advisory board sponsored by GlaxoSmithKline and served as an advisor to Momenta/Janssen. Haberman and Scher have served as advisors to Janssen, while Scher has also consulted and/or received research funding for Novartis, Pfizer, Sanofi, UCB and AbbVie. Clancy and Buyon have served as consultants to Momenta/Janssen, and Buyon has also consulted and/or served on the data security monitoring committees of Ventus, Equillium and GlaxoSmithKline. These arrangements are administered in accordance with NYU Langone’s policies and practices.