Effect of Secukinumab and Tumor Necrosis Factor Inhibitors on Humoral Response to BNT162b2 mRNA Vaccine in Patients With Spondyloarthritis Compared to Immunocompetent Controls

Tali Eviatar; Victoria Furer; Ari Polachek; Devy Zisman; Hagit Peleg; Ofir Elalouf; David Levartovsky; Ilana Kaufman; Adi Broyde; Amir Haddad; Joy Feld; Maher Aassi; Erhard Quebe-Fehling; Ivette Alarcon; Sara Pel; Daphna Paran; Ori Elkayam

doi:10.3899/jrheum.2023-0357

Effect of Secukinumab and Tumor Necrosis Factor Inhibitors on Humoral Response to BNT162b2 mRNA Vaccine in Patients With Spondyloarthritis Compared to Immunocompetent Controls

J Rheumatol. 2024 Apr 1;51(4):415-422. doi: 10.3899/jrheum.2023-0357.

Authors

Tali Eviatar¹, Victoria Furer², Ari Polachek², Devy Zisman³, Hagit Peleg⁴, Ofir Elalouf², David Levartovsky², Ilana Kaufman², Adi Broyde², Amir Haddad³, Joy Feld³, Maher Aassi⁵, Erhard Quebe-Fehling⁵, Ivette Alarcon⁵, Sara Pel², Daphna Paran², Ori Elkayam²

Affiliations

¹ T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; talieviatar@gmail.com.
² T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
⁴ H. Peleg, MD, Rheumatology Unit, Hadassah University Hospital, and the Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Jerusalem, Israel.
⁵ M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland.

PMID: 37914221
DOI: 10.3899/jrheum.2023-0357

Abstract

Objective: To assess the humoral response to the BNT162b2 mRNA vaccine among patients with spondyloarthritis (SpA) receiving secukinumab (SEC) compared to those receiving tumor necrosis factor inhibitors (TNFi) and immunocompetent controls.

Methods: Consecutive patients with psoriatic arthritis or axial SpA receiving SEC (n = 37) or TNFi (monotherapy, n = 109; + methotrexate [MTX], n = 16), immunocompetent controls (n = 122), and patients with rheumatoid arthritis (RA) receiving TNFi therapy (controls, n = 50) were vaccinated with 2 or 3 doses of the BNT162b2 vaccine. We evaluated humoral response, adverse events, and disease activity, and monitored for breakthrough coronavirus disease 2019 (COVID-19) postvaccination.

Results: The 2-dose vaccine regimen induced a comparable seropositive response in all study groups. S1/S2 antibody titers (in binding antibody units/mL; mean [SD]) were higher in the SEC group vs the TNFi + MTX-SpA and TNFi-RA groups (192.5 [68.4] vs 104.6 [46.9], P < 0.001, and 143.1 [81.9], P = 0.004). After 6 months, 96.3%, 96.6%, and 80.9% of the SEC, immunocompetent, and TNFi monotherapy-SpA groups (P = 0.10), respectively; 66.7% of the TNFi + MTX-SpA group (P = 0.03); and 63% of the TNFi-RA group (P = 0.004) remained seropositive. S1/S2 antibody titer decline was steeper in the TNFi groups than the SEC group. After the third dose, 100% of the SpA and immunocompetent and 88.9% of the TNFi-RA (P = 0.25) groups were seropositive. Rate of breakthrough COVID-19 infection was higher in the TNFi groups than in the SEC group (36-37.5% vs 10.8%). No significant between-group differences were observed for postvaccination disease activity and adverse events.

Conclusion: SEC did not interfere with the immunogenic response to BNT162b2 vaccine in patients with SpA; however, TNFi therapy was associated with lower S1/S2-antibody titers, faster decline, and higher rate of breakthrough infections.

Keywords: immunogenicity; mRNA vaccine; psoriatic; secukinumab; spondyloarthritis; tumor necrosis factor inhibitors.

MeSH terms

Antibodies, Monoclonal, Humanized*
Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / drug therapy
BNT162 Vaccine
Breakthrough Infections*
COVID-19*
Humans
Methotrexate / therapeutic use
Spondylarthritis* / drug therapy
Treatment Outcome
Tumor Necrosis Factor Inhibitors / therapeutic use
Tumor Necrosis Factor-alpha
mRNA Vaccines

Substances

Antirheumatic Agents
Tumor Necrosis Factor Inhibitors
secukinumab
mRNA Vaccines
BNT162 Vaccine
Tumor Necrosis Factor-alpha
Methotrexate
Antibodies, Monoclonal, Humanized

Supplementary concepts

COVID-19 breakthrough infections