Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine
<i>Objectives</i>: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. <i>Methods</i>: We enrolled 194 RA patients and 1002 healthcare worke...
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MDPI AG
2023-11-01
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| Series: | Vaccines |
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| author | Andrea Picchianti-Diamanti Assunta Navarra Alessandra Aiello Bruno Laganà Gilda Cuzzi Andrea Salmi Valentina Vanini Fabrizio Maggi Silvia Meschi Giulia Matusali Stefania Notari Chiara Agrati Simonetta Salemi Roberta Di Rosa Damiano Passarini Valeria Di Gioia Giorgio Sesti Fabrizio Conti Francesca Romana Spinelli Angela Corpolongo Maria Sole Chimenti Mario Ferraioli Gian Domenico Sebastiani Maurizio Benucci Francesca Li Gobbi Anna Paola Santoro Andrea Capri Vincenzo Puro Emanuele Nicastri Delia Goletti |
| author_facet | Andrea Picchianti-Diamanti Assunta Navarra Alessandra Aiello Bruno Laganà Gilda Cuzzi Andrea Salmi Valentina Vanini Fabrizio Maggi Silvia Meschi Giulia Matusali Stefania Notari Chiara Agrati Simonetta Salemi Roberta Di Rosa Damiano Passarini Valeria Di Gioia Giorgio Sesti Fabrizio Conti Francesca Romana Spinelli Angela Corpolongo Maria Sole Chimenti Mario Ferraioli Gian Domenico Sebastiani Maurizio Benucci Francesca Li Gobbi Anna Paola Santoro Andrea Capri Vincenzo Puro Emanuele Nicastri Delia Goletti |
| author_sort | Andrea Picchianti-Diamanti |
| collection | DOAJ |
| description | <i>Objectives</i>: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. <i>Methods</i>: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifestyle and demographic factors were collected at the time of the third dose, and immunogenicity analyses were carried out in a subgroup of patients at 4–6 weeks after the third dose. <i>Results:</i> BIs were experienced by 42% patients (82/194) with a median time since the last vaccination of 176 days. Older age (>50 years; aHR 0.38, 95% CI: 0.20–0.74), receiving conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (aHR 0.52, 95%CI: 0.30–0.90) and having a titre of neutralising antibodies >20 (aHR 0.36, 95% CI: 0.12–1.07) were identified as protective factors. Conversely, anti-IL6R treatment and anti-CD20 therapy increased BI probability. BIs were mostly pauci-symptomatic, but the hospitalisation incidence was significantly higher than in HCWs (8.5% vs. 0.19%); the main risk factor was anti-CD20 therapy. <i>Conclusions:</i> Being older than 50 years and receiving csDMARDs were shown to be protective factors for BI, whereas anti-IL6R or anti-CD20 therapy increased the risk. Higher neutralising antibody titres were associated with a lower probability of BI. If confirmed in a larger population, the identification of a protective cut-off would allow a personalised risk–benefit therapeutic management of RA patients. |
| first_indexed | 2024-03-09T16:23:56Z |
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| id | doaj.art-bab08bb9e0a64d5484d6ff6f1eb83027 |
| institution | Directory Open Access Journal |
| issn | 2076-393X |
| language | English |
| last_indexed | 2024-03-09T16:23:56Z |
| publishDate | 2023-11-01 |
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| series | Vaccines |
| spelling | doaj.art-bab08bb9e0a64d5484d6ff6f1eb830272023-11-24T15:10:05ZengMDPI AGVaccines2076-393X2023-11-011111168410.3390/vaccines11111684Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 VaccineAndrea Picchianti-Diamanti0Assunta Navarra1Alessandra Aiello2Bruno Laganà3Gilda Cuzzi4Andrea Salmi5Valentina Vanini6Fabrizio Maggi7Silvia Meschi8Giulia Matusali9Stefania Notari10Chiara Agrati11Simonetta Salemi12Roberta Di Rosa13Damiano Passarini14Valeria Di Gioia15Giorgio Sesti16Fabrizio Conti17Francesca Romana Spinelli18Angela Corpolongo19Maria Sole Chimenti20Mario Ferraioli21Gian Domenico Sebastiani22Maurizio Benucci23Francesca Li Gobbi24Anna Paola Santoro25Andrea Capri26Vincenzo Puro27Emanuele Nicastri28Delia Goletti29Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, ItalyEpidemiology Department, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyTranslational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyDepartment of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, ItalyTranslational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyTranslational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyTranslational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyLaboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyLaboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyLaboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyLaboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyLaboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyDepartment of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, ItalyDepartment of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, ItalyDepartment of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, ItalyDepartment of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, ItalyDepartment of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, ItalyReumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, ItalyReumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, ItalyClinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyRheumatology, Allergology and Clinical Immunology, Department of ‘Medicina dei Sistemi’, University of Rome ‘Tor Vergata’, 00133 Rome, ItalyDepartment of Rheumatology, San Camillo Hospital, 00152 Rome, ItalyDepartment of Rheumatology, San Camillo Hospital, 00152 Rome, ItalyRheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, ItalyRheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, ItalyUOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyUOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyUOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyClinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, ItalyTranslational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy<i>Objectives</i>: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. <i>Methods</i>: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifestyle and demographic factors were collected at the time of the third dose, and immunogenicity analyses were carried out in a subgroup of patients at 4–6 weeks after the third dose. <i>Results:</i> BIs were experienced by 42% patients (82/194) with a median time since the last vaccination of 176 days. Older age (>50 years; aHR 0.38, 95% CI: 0.20–0.74), receiving conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (aHR 0.52, 95%CI: 0.30–0.90) and having a titre of neutralising antibodies >20 (aHR 0.36, 95% CI: 0.12–1.07) were identified as protective factors. Conversely, anti-IL6R treatment and anti-CD20 therapy increased BI probability. BIs were mostly pauci-symptomatic, but the hospitalisation incidence was significantly higher than in HCWs (8.5% vs. 0.19%); the main risk factor was anti-CD20 therapy. <i>Conclusions:</i> Being older than 50 years and receiving csDMARDs were shown to be protective factors for BI, whereas anti-IL6R or anti-CD20 therapy increased the risk. Higher neutralising antibody titres were associated with a lower probability of BI. If confirmed in a larger population, the identification of a protective cut-off would allow a personalised risk–benefit therapeutic management of RA patients.https://www.mdpi.com/2076-393X/11/11/1684SARS-CoV-2vaccinerheumatoid arthritisimmunogenicityneutralising antibodiesimmunosuppressive therapy |
| spellingShingle | Andrea Picchianti-Diamanti Assunta Navarra Alessandra Aiello Bruno Laganà Gilda Cuzzi Andrea Salmi Valentina Vanini Fabrizio Maggi Silvia Meschi Giulia Matusali Stefania Notari Chiara Agrati Simonetta Salemi Roberta Di Rosa Damiano Passarini Valeria Di Gioia Giorgio Sesti Fabrizio Conti Francesca Romana Spinelli Angela Corpolongo Maria Sole Chimenti Mario Ferraioli Gian Domenico Sebastiani Maurizio Benucci Francesca Li Gobbi Anna Paola Santoro Andrea Capri Vincenzo Puro Emanuele Nicastri Delia Goletti Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine Vaccines SARS-CoV-2 vaccine rheumatoid arthritis immunogenicity neutralising antibodies immunosuppressive therapy |
| title | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
| title_full | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
| title_fullStr | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
| title_full_unstemmed | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
| title_short | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
| title_sort | older age a high titre of neutralising antibodies and therapy with conventional dmards are associated with protection from breakthrough infection in rheumatoid arthritis patients after the booster dose of anti sars cov 2 vaccine |
| topic | SARS-CoV-2 vaccine rheumatoid arthritis immunogenicity neutralising antibodies immunosuppressive therapy |
| url | https://www.mdpi.com/2076-393X/11/11/1684 |
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