COVID-19 Vaccine in the Autoimmune Population – Where are We Now?

COVID-19 Vaccine in the Autoimmune Population – Where are We Now?

There are many factors that can influence a response to any vaccine or treatment including the interactions with a specific disease/s, prescribed or over the counter medication being taken, the mechanism behind the medication, how long a person has been on a medication and medical history (specifically their history of infection). While for many the COVID-19 vaccine is yielding a return to a level of normality, those who are immune compromised and taking medications, the possibility of reaction has another layer of complexity.

The large range in type of conditions and drugs that impact the immune system explain why the response to the COVID-19 has been so varied among this group. The drugs that appear linked with the poorest response include mycophenolate (prevents organ rejection), rituximab (treats some blood cancers and autoimmune diseases like rheumatoid arthritis), belatacept (prevents organ rejection) and methotrexate (treats a wide range of cancers and autoimmune diseases).

Studies specific to those with rheumatic disease who received both doses of a mRNA vaccine found nearly all recipients had detectable antibodies. However, those on rituximab or mycophenolate had very low levels. Patients taking anti-inflammation drugs, called tumor necrosis factor (TNF) inhibitors, to treat Crohn’s disease or rheumatoid or psoriatic arthritis had strong antibody responses. Prednisone, often used by autoimmune patients during a flare, also resulted in lower antibody levels.

Both the FDA and CDC recommend against antibody testing as it is not yet known if there is a minimum level of antibodies that assures protection. When determining how to define protection, Immunological response and how effective a vaccine are two different things as vaccines work on multiple levels and induce immunity in multiple ways. One way is through stimulation of B cells to produce antibodies which explains why medication the decrease B cells such as rituximab, methotrexate, mycophenolate, and steroids—resulting in reduced antibody production. Vaccines also stimulate killer T cells, which attack infected cells and helper T cells which help both B cells and killer T cells. Vaccines result in the production of memory B cells ensuring a rapid response should a person become infected.

Information on level of protection and effectiveness can only be achieved with data that compares infections between vaccinated and unvaccinated people in different immune-compromised groups. Developing this kind of research and data can only be done over time; it is not an immediate process. As the booster is becoming more readily available throughout the country, many who are immune compromised are heeding the advice of the CDC and getting the vaccine but preceding with caution and paying special attention to any side effects.

As always, it’s also important to discuss individual situations with a treating physician to get advice about specific conditions and treatment protocols.

Sources:

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-07/07-COVID-Oliver-508.pdf

https://asm.org/Articles/2021/August/How-Effective-Are-COVID-19-Vaccines-in-Immunocompr

https://www.scientificamerican.com/article/how-immunocompromised-people-without-strong-vaccine-protection-are-coping-with-covid/

https://www.ukri.org/news/vaccine-responses-in-patients-with-impaired-immune-systems/

Article Author
Arthritis National Research Foundation
arthritisresearch@curearthritis.org

The Arthritis National Research Foundation's mission is to provide initial research funding to brilliant, investigative scientists with new ideas to cure arthritis and related autoimmune diseases. There are several ways to support research through the ANRF. Find out more and donate today.

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