Impaired Antibody Response to the BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccine in Patients With Systemic Lupus Erythematosus and Rheumatoid Arthritis

Ammitzbøll, Christian; Bartels, Lars Erik; Bøgh Andersen, Jakob; Risbøl Vils, Signe; Elbæk Mistegård, Clara; Dahl Johannsen, Anders; From Hermansen, Marie‐Louise; Kragh Thomsen, Marianne; Erikstrup, Christian; Hauge, Ellen‐Margrethe; Troldborg, Anne

OBJECTIVE: With a vaccine effectiveness of 95% for preventing coronavirus disease 2019 (COVID‐19), Pfizer‐BioNTech BNT162b2 (BNT162b2) was the first vaccine against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) to be approved. However, immunosuppressive therapy was an exclusion criterion in the phase 3 trial that led to approval. Thus, extrapolation of the trial results to patients with rheumatic diseases treated with immunosuppressive drugs warrants caution. METHODS: Patients with systemic lupus erythematosus (SLE; n = 61) and rheumatoid arthritis (RA; n = 73) were included from the COPANARD (Corona Pandemic Autoimmune Rheumatic Disease) cohort, followed since the beginning of the COVID‐19 pandemic. Patients received the BNT162b2 vaccine between December 2020 and April 2021. All patients had total antibodies against SARS‐CoV‐2 measured before vaccination and 1 week after the second vaccination (VITROS Immunodiagnostic Products). RESULTS: Of 134 patients (median age, 70 years), 77% were able to mount a detectable serological response to the vaccine. Among patients treated with rituximab, only 24% had detectable anti–SARS‐CoV‐2 antibodies in their serum after vaccination. The time since the last rituximab treatment did not seem to influence the vaccine response. No significant difference was observed between patients with RA or SLE when adjusting for treatment, and no correlation between antibody levels and age was detected (r = −0.12; P = 0.18). CONCLUSION: Antibody measurements against SARS‐CoV‐2 in patients with RA and SLE after two doses of the BNT162b2 vaccine demonstrated that 23% of patients could not mount a detectable serological response to the vaccine. B cell–depleting therapy (BCDT) is of specific concern, and our findings call for particular attention to the patients receiving BCDT.