Universität zu Köln

Stahl, David, Pesch, Carola Tho, Bruck, Carolin, Esser, Ruth L., Thiele, Jan, Di Cristanziano, Veronica and Kofler, David M. (2022). Reduced humoral response to a third dose (booster) of SARS-CoV-2 mRNA vaccines by concomitant methotrexate therapy in elderly patients with rheumatoid arthritis. RMD Open, 8 (2). LONDON: BMJ PUBLISHING GROUP. ISSN 2056-5933

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Abstract

Background Several health authorities recommend a third (booster) vaccination to protect patients with rheumatic and musculoskeletal diseases from severe COVID-19. Methotrexate has been shown to reduce the efficacy of the first and second dose of SARS-CoV-2 mRNA vaccines. So far, it remains unknown how concomitant methotrexate affects the efficacy of a COVID-19 booster vaccination. Methods We compared the humoral immune response to SARS-CoV-2 vaccination in 136 patients with rheumatoid arthritis (RA) treated with methotrexate and/or biological or targeted synthetic (b/tsDMARDs). IgG targeting the receptor binding domain (RBD) of SARS-CoV-2 spike protein was measured at a median of 52.5 (range 2-147) days after a third dose of the SARS-CoV-2 mRNA vaccines BNT162b2 or mRNA-1273. Results Anti-RBD IgG was significantly reduced in elderly patients receiving concomitant treatment with methotrexate as compared with elderly patients receiving monotherapy with b/tsDMARDs or methotrexate (64.8 (20.8, 600.3) binding antibody units per mL (BAU/mL) vs 1106.0 (526.3, 4965.2) BAU/mL vs 1743.8 (734.5, 6779.6) BAU/mL, median (IQR), p<0.001, Kruskal-Wallis test). In younger patients (< 64.5 years), concomitant methotrexate had no significant impact on the humoral immune response. Conclusions Concomitant methotrexate increases the risk of an insufficient humoral immune response to SARS-CoV-2 vaccination in elderly patients with RA. Pausing methotrexate during the third vaccination period may be considered for this group of patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Stahl, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Pesch, Carola Tho UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruck, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Esser, Ruth L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Thiele, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Di Cristanziano, Veronica UNSPECIFIED UNSPECIFIED UNSPECIFIED Kofler, David M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-662286
DOI:	10.1136/rmdopen-2022-002632
Journal or Publication Title:	RMD Open
Volume:	8
Number:	2
Date:	2022
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	2056-5933
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Rheumatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/66228