J Rheum Dis.  2024 Jan;31(1):15-24. 10.4078/jrd.2023.0054.

Clinical and immunological responses to COVID-19 vaccination in rheumatoid arthritis patients on disease modifying antirheumatic drugs: a cross-sectional study

• Eerike M
• Parimi VP
• Pyati A
• Sundaramurthy R
• Sakthivadivel V
• Pidugu AB
• Surapareddy B
• Ramineni NT
• Priyadarshini R
• Patil PP

• KMID: 2549632
• DOI: http://doi.org/10.4078/jrd.2023.0054

Abstract

Objective
This study was conducted to investigate the immunological and clinical response to COVID-19 vaccination in rheumatoid arthritis (RA) patients receiving disease modifying antirheumatic drugs (DMARDs).
Methods
A cross-sectional study was conducted among RA patients who received two doses of COVID-19 vaccine within 6 months to one year. Demographic information, comorbidities, vaccination details, and past COVID-19 infection details were collected. Hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were estimated. Disease Activity Score-28 (DAS-28) was calculated for RA patients. Anti-spike antibody (ASA) concentrations were measured, and compared with a healthy control population. Correlations of ASA with age, sex, disease parameters, medication use, and comorbidities were assessed.
Results
A total of 103 RA patients and 185 controls were included in the study. RA patients had higher mean age, lower mean Hb, higher ESR, and elevated IL-6 levels. Both groups showed positive results for anti-spike antibodies, with a higher percentage in controls. Among RA patients majority had low DAS-28 score. The number of DMARDs used showed a negative correlation with antibody levels. There was a slight positive correlation between ASA concentration and DAS-28 score. Comorbidities did not significantly influence antibody concentration. No significant differences were found in antibody levels based on the type of COVID-19 vaccine or previous COVID-19 infection or booster dose vaccination among RA patients.
Conclusion
The study revealed that RA patients showed a reduced antibody response following COVID-19 vaccination compared to the control group and potentially influenced by immunosuppressive treatments and disease-related factors.

Keyword

COVID-19; Vaccination; Rheumatoid arthritis; Anti-spike antibody; Disease-modifying antirheumatic drugs

Figure

• 

  Figure 1 llustration of study participants enrollment and progression. IEC: Institutional Ethics Committee, RA: rheumatoid arthritis, HTN: hypertension.

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  Figure 2 Correlation of anti-spike antibodies concentration with DAS-28 score (A), DMARDs (B), IL-6 (C), and association of comorbidities (D) among RA cases (n=103). DAS-28: Disease Activity Score-28, DMARDs: disease modifying anti-rheumatic drugs, IL-6: interleukin-6, RA: rheumatoid arthritis. p<0.05 is considered statistically significant.

• 

  Figure 3 Box-Whisker plot for serum levels of anti-spike antibodies among control (A) and RA group (B). RA: rheumatoid arthritis. p-value <0.001 is considered as statistically highly significant. Refer to Table 1.

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