COVID-19 vaccine may not be enough protection for those with RMD

June 8, 2021

Researchers at Johns Hopkins Medicine have found lower-than-normal immune response to the messenger RNA (mRNA) COVID-19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs), conditions that often call for treatment with medications that suppress the immune system, according to a news release.

The researchers previously had reported that while two doses of a vaccine against SARS-CoV-2 confers some protection for people who have received solid organ transplants, it isn’t sufficient to enable them to dispense with masks, physical distancing, and other safety measures.

The new study was detailed in a research letter published May 25 in the Annals of Internal Medicine.

According to the American College of Rheumatology, RMDs are a diverse group of autoimmune diseases that affect children and adults, and can impact any organ of the body, often the joints. Most RMDs are due to problems of the immune system, which can result in inflammation and gradual deterioration of joints, muscles and bones. Over 46 million people in the United States are living with some type of RMD, including rheumatoid arthritis, systemic lupus erythematosus, scleroderma, vasculitis and Sjögren’s syndrome.

Between December 7, 2020, and March 11, 2021, the Johns Hopkins Medicine researchers recruited patients who were at least 18 years old with RMDs for the immune response study. One month after the participants received their second dose of either the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccine, blood samples were analyzed for neutralizing antibodies against the target of both vaccines, the SARS-CoV-2 spike protein.

Twenty patients did not have detectable antibodies. The majority were women (95%), white (90%), diagnosed with lupus (50%) and receiving multiple immunosuppressive agents (80%) — of which the most common medications were rituximab (55%), a biologic used to treat autoimmune disorders such as rheumatoid arthritis and vasculitis, and mycophenolate (50%), a drug commonly used as a first-line therapy for scleroderma lung disease and lupus nephritis (kidney inflammation). Both immune suppressants work by depleting B-lymphocytes (also known as B-cells), immune cells that produce antibodies in response to foreign invaders such as bacteria and viruses.

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