ARTICLE: Absence of Humoral Response After Two-Dose SARS-CoV-2 Messenger RNA Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: A Case Series

AUTHORS: Caoilfhionn M Connolly, Brian J Boyarsky, Jake A Ruddy, William A WerbelLisa Christopher-Stine, Jacqueline M Garonzik-Wang, Dorry L Segev, Julie J Paik

JOURNAL: Ann Intern Med. 2021 May 25. doi: 10.7326/M21-1451. Online ahead of print.


Background: Patients with rheumatic and musculoskeletal diseases (RMDs) are at increased risk for SARS-CoV-2 infection because of both the immunomodulatory effects of their underlying diseases and treatment with immunosuppressive agents. Early data have suggested limited immunogenicity of SARS-CoV-2 messenger RNA (mRNA) vaccines in immunocompromised patients (1), and although most patients with RMDs developed a robust response to the first dose of the mRNA vaccine (2), an important subset of patients did not mount an appreciable humoral response. Thus, we sought to analyze a subset of 20 patients with RMDs who did not develop a detectable antibody response 1 month after completion of 2-dose mRNA vaccination against SARS-CoV-2.

Objective: To evaluate the clinical characteristics of patients with RMDs and absence of a humoral vaccine response.

Case Report: Patients aged 18 years or older with RMDs were recruited to participate in this prospective cohort assessing SARS-CoV-2 vaccine response through a digital campaign between 7 December 2020 and 11 March 2021. Demographic characteristics, diagnoses, and immunosuppressive regimens were collected. One month after the second dose, venipuncture samples were obtained and tested on the semiquantitative Elecsys anti–SARS-CoV-2 S enzyme immunoassay (Roche), which tests for antibodies against the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein—a consistent correlate of neutralizing antibody (3). Twenty participants with undetectable anti-RBD antibodies were included in this case series. This study was approved by the Johns Hopkins Institutional Review Board.

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