159. SARS-COV-2 vaccine responses in immunosuppressed patient populations
Creators: name: Rona M Smith2, 1
name: Cooper1, Daniel J
name: Doffinger1, Rainer
name: Stacey1, Hannah
name: Abdulrahman Al-Mohammad2
name: Lee2, Jacinta
name: Vilar3, Enric
name: Cheung4, Chee Kay
name: Rachel Jones1, 2
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background: </strong>Dialysis patients and immunosuppressed renal patients are at increased risk of COVID-19 and were excluded from vaccine trials. We conducted a prospective multicentre study to assess SARS-CoV-2 vaccine antibody responses in dialysis patients and renal transplant recipients, and patients receiving immunosuppression for autoimmune disease. <strong>Methods: </strong>Patients were recruited from four UK centres (ethics:20/EM/0180) and compared to healthy controls (ethics:17/EE/0025). SARS-CoV-2 IgG antibodies to spike protein were measured using a multiplex Luminex assay, after first, second and third doses of Pfizer BioNTech BNT162b2(Pfizer) or Oxford-AstraZeneca ChAdOx1nCoV-19(AZ) vaccine. Clinical data on COVID19 infection and immunosuppression was collected from patient interviews and electronic medical records. <strong>Results: </strong>692 patients were included (260 dialysis, 209 transplant, 223 autoimmune disease (prior rituximab 128(57%)) and 144 healthy controls. 299(43%) patients received Pfizer vaccine and 379(55%) received AZ. Median age was 62 (range 19 – 95) years. At time of assessment of second vaccine response prior PCR confirmed SARS-CoV-2 infection was documented in 39 individuals (6%). In the autoimmune population, disease subgroups were classified as: ANCA-associated vasculitis (AAV) 133 (60%); systemic lupus erythematosus (SLE) 27 (12%); large vessel vasculitis 11 (5%) and other 52 (24%). 128 patients had received rituximab, a median of 162 (IQR 110 – 275) days prior to vaccination Following two vaccine doses, positive responses occurred in 96% dialysis, 52% transplant, 70% autoimmune patients and 100% of healthy controls. In dialysis patients, higher antibody responses were observed with Pfizer vaccination. Predictors of poor antibody response were triple immunosuppression (adjusted odds ratio [aOR]0.016;95%CI0.002-0.13;p&lt;0.001) and mycophenolate mofetil (MMF) (aOR0.2;95%CI 0.1-0.42;p&lt;0.001) in transplant patients; rituximab within 12 months in autoimmune patients (aOR0.29;95%CI 0.008–0.096;p&lt;0.001) and patients receiving immunosuppression with chronic kidney disease stage 4 (eGFR 15-29ml/min, aOR0.031;95%CI 0.11–0.84;p=0.021) (see Figure). After second vaccine dose median s-antibody titres correlated strongly with time from most recent rituximab treatment (Spearman’s correlation coefficient 0.46; p&lt;0.001), with increasing time from dose correlating with higher s-antibody titres. A lower median s-antibody was seen in those who had received Rituximab in the 6 months preceding a second vaccine dose (690 [IQR 175 – 12,767] compared to receiving a second vaccine dose greater than 6 months since most recent Rituximab treatment (27,975 (1,534 – 31,199); p&lt;0.001. Samples after third vaccine dose are currently being processed and analysis of antibody responses will be complete by April 2022. <strong>Conclusions</strong>: Amongst dialysis, kidney transplant and autoimmune populations SARS-CoV-2 vaccine antibody responses are reduced compared to healthy controls. Following two vaccine doses a reduced response to vaccination was associated with rituximab in autoimmune patients, MMF and triple immunosuppression in transplant patients and immunosuppression use in CKD stage 4. Vaccine responses increased after second dose, suggesting low-responder groups should be prioritised for repeated vaccination. Greater antibody responses were observed with the mRNA Pfizer vaccine compared to adenovirus AZ vaccine in dialysis patients suggesting that Pfizer SARS-CoV-2 vaccine should be the preferred vaccine choice in this sub-group. <strong>Disclosures:</strong> RS has received grants from GlaxoSmithKline (GSK) and Union Therapeutics<strong>. </strong>RJ has received grants/consultancy fees from GSK, Vifor Pharma, ChemoCentryx and Roche