Humoral Response to SARS-CoV-2 Vaccine of a Patient Receiving Methotrexate Treatment and Implications for the Need of Monitoring

Krzysztof Lukaszuk; Izabela Woclawek-Potocka; Grzegorz Jakiel; Paulina Malinowska; Artur Wdowiak; Karolina Rozanska; Lukasz Rabalski

doi:10.3390/vaccines9101151

Humoral Response to SARS-CoV-2 Vaccine of a Patient Receiving Methotrexate Treatment and Implications for the Need of Monitoring

Vaccines (Basel). 2021 Oct 9;9(10):1151. doi: 10.3390/vaccines9101151.

Authors

Krzysztof Lukaszuk^{1

2}, Izabela Woclawek-Potocka³, Grzegorz Jakiel⁴, Paulina Malinowska², Artur Wdowiak⁵, Karolina Rozanska², Lukasz Rabalski⁶

Affiliations

¹ Department of Obstetrics and Gynecology Nursing, Medical University of Gdansk, 80-211 Gdansk, Poland.
² Invicta Research and Development Center, 81-740 Sopot, Poland.
³ Department of Gamete and Embryo Biology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10-243 Olsztyn, Poland.
⁴ The Center of Postgraduate Medical Education, 1st Department of Obstetrics and Gynecology, 01-004 Warsaw, Poland.
⁵ Diagnostic Techniques Unit, Medical University of Lublin, 20-081 Lublin, Poland.
⁶ Laboratory of Recombinant Vaccines, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, 80-307 Gdansk, Poland.

Abstract

We report a case of monitoring the antibody response to the BioNTech-Pfizer vaccine of a 50-year-old female diagnosed with rheumatoid arthritis undergoing treatment with methotrexate (MTX). Antibody levels were measured 21 days after dose 1 (i.e., on the day of dose 2) and then 8, 14 and 30 days after dose 2 with Elecsys Anti-SARS-CoV-2 S assay (Roche Diagnostics). Patient showed a negative result after dose 1 and had the serum sample retested using a LIAISON^® SARS-CoV-2 TrimericS IgG assay (DiaSorin), which showed a positive result. Subsequent samples were tested using both assays. Antibody levels kept increasing but at a much slower rate than in patients not receiving any immunomodulatory therapies. Other research indicates that among patients with autoimmune diseases, those receiving disease-modifying antirheumatic drugs (DMARDs) have higher COVID-19 mortality than those treated with tumor necrosis factor inhibitors (TNFis). These results indicate the need for people with autoimmune diseases to be carefully observed following vaccinations, including testing of antibody levels, and treated as potentially at risk until the effect of vaccination is confirmed. The different available vaccines should also be tested to verify their usefulness in the case of people with autoimmune diseases and those who take different immunomodulatory medications.

Keywords: AIIRD; COVID-19; TNFis; autoimmune disease; methotrexate; vaccination.

Publication types

Case Reports