Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

Maurizio Benucci; Arianna Damiani; Maria Infantino; Mariangela Manfredi; Barbara Lari; Valentina Grossi; Elena Biancamaria Mariotti; Alberto Corrà; Cristina Aimo; Lavinia Quintarelli; Alice Verdelli; Francesca Li Gobbi; Emiliano Antiga; Marzia Caproni

doi:10.3389/fmed.2022.811829

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

Front Med (Lausanne). 2022 Feb 28:9:811829. doi: 10.3389/fmed.2022.811829. eCollection 2022.

Affiliations

¹ Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro Florence, Florence, Italy.
² Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
³ Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy.
⁴ Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy.
⁵ Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy.

Abstract

Background: A few studies on vaccination in patients with rheumatic diseases, including arthritis, connective tissue diseases, vasculitis, and psoriatic arthropathy (PsA), demonstrated reduced production of neutralizing antibodies to SARS-CoV-2 Spike RBD (receptor-binding domain contained in the N-terminal of the S1 globular head region) when compared to the general population.

Objective: The aim of our study was to observe whether different therapies for PsA [methotrexate, anti-TNF antibodies, soluble TNF receptor (etanercept) or IL-17 inhibitors] have a different impact on SARS-CoV-2 vaccination in a homogeneous population of patients.

Methods: We enrolled 110 PsA patients in remission, assessed with Disease Activity in PSoriatic Arthritis (DAPSA). Of these: 63 were in treatment with anti-TNF-α therapy (26 etanercept, 15 certolizumab, 5 golimumab, 17 adalimumab); 37 with anti-IL17 secukinumab; 10 with methotrexate. All patients underwent vaccination for SARS-CoV-2 with mRNA BNT162b2 vaccine. Assessment of absolute and percentage lymphocyte subsets and anti-SARS-CoV-2 Spike RBD IgG antibody value 3 weeks after the second vaccine dose were performed. In addition, the serum antibody levels of 96 healthy healthcare workers (HCW) were analyzed.

Results: The mean disease activity assessed with DAPSA score was 2.96 (SD = 0.60) with no significant differences between patients under different medications (p = 0.779). Median levels of neutralizing antibodies to SARS-CoV-2 Spike RBD were 928.00 binding antibody unit (BAU)/mL [IQR 329.25, 1632.0]; 1068.00 BAU/ml [IQR 475.00, 1632.00] in patients taking MTX, 846.00 BAU/ml [IQR 125.00, 1632.00] in patients taking etanercept, 908.00 BAU/mL [IQR 396.00, 1632.00] in patients taking anti-IL17 and 1148.00 BAU/ml [IQR 327.00, 1632.00] in patients taking TNF-α inhibitors, without statistically significant differences between these groups. Mean serum antibody level of HCW group was 1562.00 BAU/ml [IQR 975.00, 1632.00], being significantly higher than in the patient group (p = 0.000816). Absolute and percentage count of lymphocyte subsets were not statistically different between the subgroups under different treatments and when compared with HCW.

Conclusions: As for other rheumatic diseases on immunomodulatory treatment, our data showed a reduced humoral response in PsA patients compared to the control group. However, antibody response did not significantly differ between groups treated with different medications.

Keywords: BNT162b2; DMARDs; SARS-CoV-2 vaccination; biologics; mRNA COVID-19 vaccine; psoriatic arthritis.