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Effectiveness Of A SARS-COV-2 Vaccination Schedule Including A Booster Dose in Patients with Systemic Lupus Erythematosus: Data from A Prospective Multicenter Study

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Natalia Sarzi Sartori  *,
Ketty Lysie Libardi Lira Machado,
Samira Tatiyama Miyamoto,Flavia Zon Prettiti,
Maria da Penha Gomes Gouvea,
Yasmin Gurtler Pinheiro Oliveira,
Venezia Gonçalves da Silva,Filipe Faé,
Ana Paula Neves Burian,
Karina Rosemarie Lallemand Tapia,Anna Carolina Simões Moulin,Luiza Lorenzoni Grillo,Paula dos Santos Athayde,
Helena da Silva Corona,
Sabrina de Souza Ramos,Flávia Maria Matos Melo Campos Peixoto,Priscila Dias Cardoso Ribeiro,
Vanessa de Oliveira Magalhães,
Mariana Freitas de Aguiar,
Erika Biegelmeyer,
Cristiane Kayser,
Alexander Wagner Silva De Souza,
Charlles Heldan Moura Castro,Juliana Bühring,Sandra Lúcia Euzébio Ribeiro,Sérgio Henrique Oliveira dos Santos,
Clara Pinheiro Martins,
Jonathan Wilian da Silva Rodrigues,Marcos Mavignier Souza Dias,Bruna Guimarães Dutra,
Camila Maria Paiva França Telles,
Samuel Elias Basualto Dias,Andrese Aline Gasparin,
Vanessa Hax,
Rodrigo Poubel Vieira Rezende,Katia Lino Baptista,Rodrigo Cutrim Gaudio,Ana Karla Guedes Melo,Valéria Bezerra da Silva,Vitor Alves Cruz,Joselia Rego,
Rejane Maria Rodrigues de Abreu Vieira,
Adah Sophia Rodrigues Vieira,
Adriana Maria Kakehasi,
Anna Carolina Faria Moreira Gomes Tavares,Victória Dornelas Paz Carvalho,Renata Henriques de Azevedo,
Valderilio Feijó Azevedo,
Olindo Assis Martins Filho,
Vanessa Peruhype-Magalhães,
Valeria Valim,
Emilia Inoue Sato,
Andrea Teixeira-Carvalho,
Viviane Angellina de Souza,
Gilda Aparecida Ferreira,Edgard Torres Reis-Neto,Marcelo de Medeiros Pinheiro,
Ricardo Machado Xavier,
Gecilmara Salviato Pileggi,
Odirlei André Monticielo  *

This version is not peer-reviewed

Submitted:

21 November 2024

Posted:

22 November 2024

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Abstract
Objective: To evaluate the humoral response to and effectiveness of SARS-CoV-2 vaccination in patients with systemic lupus erythematosus in a multicenter cohort design. Methods: Data for this analysis were obtained from the Study of Safety, Effectiveness and Duration of Immunity after Vaccination against SARS-CoV-2 in Patients with Immune-Mediated Inflammatory Diseases (SAFER), a prospective, multicenter, phase IV, real-world study conducted across different regions of Brazil. Patients aged >18 years with systemic lupus erythematosus (SLE) who received any one of the SARS-CoV-2 vaccines approved by the Brazilian health regulatory agency (CoronaVac [Inactivated SARS-CoV-2 Vaccine], ChAdOx-1 [AstraZeneca], or BNT162b2 [Pfizer-BioNTech]) were included. Immunogenicity was assessed in pre- and post-vaccination blood samples, and patients were monitored in person and remotely for incident COVID-19 cases and their severity. Results: Two hundred and thirty-five patients with SLE who had completed their vaccination schedules (2 doses + booster dose) were included in this study. Most patients were female (89.3%) and had low disease activity or were in remission (72.4%); the majority were also on some form of immunosuppressive therapy (58.1%). One hundred and sixteen patients received 2 doses of CoronaVac followed by 1 dose of BNT162b2 (Pfizer-BioNTech) vaccine, 87 received 2 doses of ChAdOx1-S (AstraZeneca) followed by 1 dose of BNT162b2 (Pfizer-BioNTech) vaccine, and 32 received 3 doses of BNT162b2 (Pfizer-BioNTech) vaccine. Twenty-eight incident cases of COVID-19, none meeting severity criteria, were recorded in patients with respiratory symptoms after the second dose of a SARS-CoV-2 vaccine. Regarding immunogenicity, an increase in seroconversion rate was observed, with no difference between vaccination schedules, reaching 97.57% seropositivity after a booster dose. The increases in geometric mean IgG titers differed between the different vaccination schedules, being lowest for the CoronaVac-based schedule, but titers were similar after administration of a booster dose. Conclusion: In patients with SLE, SARS-CoV-2 vaccines are immunogenic and effective in reducing severe disease and hospitalization. Complete vaccination schedules including a booster dose were associated with induction of a greater humoral response, especially in patients initially immunized with an inactivated virus vaccine schedule and those with a suboptimal humoral response.
Keywords: 
Subject: Medicine and Pharmacology  -   Medicine and Pharmacology
Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.
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