Immunosuppressed Patients Respond to Booster Shots: Hope for a COVID Booster Vaccine for Lupus and Other Autoimmune Disease Patients? [Updated 8/12/21]
Will a COVID Booster Vaccine for Lupus Patients Increase Response Rates?
We do not know, yet. However, the August 12, 2021 edition of the New England Journal of Medicine reported significant responses in immunosuppressed organ transplant patients. This gives lupus patients, and other immunosuppressed autoimmune disease patients, hope that they may also respond well to a COVID booster vaccine.
The Problem: Early reports from COVID vaccine studies suggest that patients on immunosuppressants have lower response rates. The Johns Hopkins Hospital study has already suggested that patients on mycophenolate mofetil, rituximab, and steroids (when combined with another immunosuppressants) have high rates of nonresponse.
This leaves immunosuppressed patients, such as lupus patients, unsure of how well they responded to their COVID vaccines and they must remain vigilant with social distancing, mask wearing, etc. Unfortunately, the usual COVID antibody tests available to most doctors do not test for antibodies to the SARS-Cov-2 spike protein, which is essential to test for vaccine responses, so few patients know if they responded or not.
The COVID Booster Vaccine Study in Immunosuppressed Patients:
Who were tested?
-101 organ transplant patients who were immunosuppressed
-Toulouse University Hospital, Toulouse, France
What immunosuppressant drugs were they on?
– 63% were on mycophenolate mofetil (CellCept)
– 87% were on steroids (like prednisone)
– 79% were on calcineurin inhibitors (such as tacrolimus and cyclosporin)
– Others were on others such as mammalian target of rapamycin inhibitors, and belatacept
How were they vaccinated against COVID-19?
– All received the Pfizer-BioNTech RNA vaccine
– The 2nd dose was given 1 month after the first dose
– The booster vaccine (shot #3) was given around 2 months after dose #2
What Were The Results of the COVID Booster Vaccine Study?
Only 40% of the patients had an antibody response after the typical 2nd Pfizer dose
68% had a COVID-19 spike protein antibody response 1 month after the booster shot (the 3rd dose)
Antibody levels increased from just 36 +/- 12 before the booster shot to 2676 +/- 350 after the booster shot!! That is amazing!!
None of the patients had any serious side effects to the vaccines
None of the patients developed COVID-19 after all 3 shots
Those less likely to respond = elderly, those with decreased kidney function, and those on the most immunosuppressants
Take-Aways from This Study
- Many of these organ transplant patients were immunosuppressed on drugs commonly used in lupus patients (mycophenolate and steroids)
- It appears from other preliminary study results that too many immunosuppressed patients are not responding to the current dosing of COVID-19 vaccines
- It is very impressive how antibody levels went from 36 before the booster shot to 2676 after the booster shot!
- My prediction: A COVID booster vaccine for lupus patients and other autoimmune disease patients has a high chance of increasing immunity against COVID-19
- However, we do not know for sure. This study was not a study of lupus patients.
- Even though a significantly higher number of immunosuppressed patients responded, 32% had still not responded.
- All immunosuppressed patients should get vaccinated. Thus far they appear to be safe and significant numbers of patients do respond.
- We need COVID booster vaccine for lupus patient studies performed as soon as possible to answer these questions.
Update from 8/12/21:
Moderna Booster Study also showed increased responsiveness
The NEJM also reported that a similar study performed on 120 organ transplant patients using the Moderna COVID-19 booster shot (a 3rd shot) resulted in much better response rates. This study was done in Toronto, Canada by VG Hall et al. This is even more evidence that there is hope for the need of a COVID booster vaccine for lupus patients in the future!
PLEASE COMMENT ON THESE STUDIES > WHAT ARE YOUR THOUGHTS, CONCERNS regarding the possibility of a COVID booster vaccine for lupus patients?
AUTHOR: Donald Thomas, MD
Kamar N, Abravanel F, Marion O, Couat C, Izopet J, Del Bello A. Three Doses of an mRNA Covid-19 Vaccine in Solid-Organ Transplant Recipients. N Engl J Med. 2https://www.nejm.org/doi/10.1056/NEJMc2108861021 Aug 12;385(7):661-662. doi: 10.1056/NEJMc2108861. Epub 2021 Jun 23. PMID: 34161700; PMCID: PMC8262620.
Hall VG, et al “Randomized trial of a third dose of mRNA-1273 vaccine in transplant recipients” N Engl J Med 2021; DOI: 10.1056/NEJMc2111462.