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Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients

Patients with heart transplantation (HT) have an increased risk of COVID-19 disease and the efficacy of vaccines on antibody induction is lower, even after three or four doses. The aim of our study was to assess the efficacy of four doses on infections and their interplay with immunosuppression. We...

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Autores principales: Masetti, Marco, Scuppa, Maria Francesca, Aloisio, Alessio, Giovannini, Laura, Borgese, Laura, Manno, Stefania, Tazza, Beatrice, Pascale, Renato, Bonazzetti, Cecilia, Caroccia, Natascia, Sabatino, Mario, Spitaleri, Giosafat, Viale, Pierluigi, Giannella, Maddalena, Potena, Luciano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053932/
https://www.ncbi.nlm.nih.gov/pubmed/36985328
http://dx.doi.org/10.3390/microorganisms11030755
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author Masetti, Marco
Scuppa, Maria Francesca
Aloisio, Alessio
Giovannini, Laura
Borgese, Laura
Manno, Stefania
Tazza, Beatrice
Pascale, Renato
Bonazzetti, Cecilia
Caroccia, Natascia
Sabatino, Mario
Spitaleri, Giosafat
Viale, Pierluigi
Giannella, Maddalena
Potena, Luciano
author_facet Masetti, Marco
Scuppa, Maria Francesca
Aloisio, Alessio
Giovannini, Laura
Borgese, Laura
Manno, Stefania
Tazza, Beatrice
Pascale, Renato
Bonazzetti, Cecilia
Caroccia, Natascia
Sabatino, Mario
Spitaleri, Giosafat
Viale, Pierluigi
Giannella, Maddalena
Potena, Luciano
author_sort Masetti, Marco
collection PubMed
description Patients with heart transplantation (HT) have an increased risk of COVID-19 disease and the efficacy of vaccines on antibody induction is lower, even after three or four doses. The aim of our study was to assess the efficacy of four doses on infections and their interplay with immunosuppression. We included in this retrospective study all adult HT patients (12/21–11/22) without prior infection receiving a third or fourth dose of mRNA vaccine. The endpoints were infections and the combined incidence of ICU hospitalizations/death after the last dose (6-month survival rate). Among 268 patients, 62 had an infection, and 27.3% received four doses. Following multivariate analysis, three vs. four doses, mycophenolate (MMF) therapy, and HT < 5 years were associated with an increased risk of infection. MMF ≥ 2000 mg/day independently predicted infection, together with the other variables, and was associated with ICU hospitalization/death. Patients on MMF had lower levels of anti-RBD antibodies, and a positive antibody response after the third dose was associated with a lower probability of infection. In HT patients, a fourth dose of vaccine against SARS-CoV-2 reduces the risk of infection at six months. Mycophenolate, particularly at high doses, reduces the clinical effectiveness of the fourth dose and the antibody response to the vaccine.
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spelling pubmed-100539322023-03-30 Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients Masetti, Marco Scuppa, Maria Francesca Aloisio, Alessio Giovannini, Laura Borgese, Laura Manno, Stefania Tazza, Beatrice Pascale, Renato Bonazzetti, Cecilia Caroccia, Natascia Sabatino, Mario Spitaleri, Giosafat Viale, Pierluigi Giannella, Maddalena Potena, Luciano Microorganisms Article Patients with heart transplantation (HT) have an increased risk of COVID-19 disease and the efficacy of vaccines on antibody induction is lower, even after three or four doses. The aim of our study was to assess the efficacy of four doses on infections and their interplay with immunosuppression. We included in this retrospective study all adult HT patients (12/21–11/22) without prior infection receiving a third or fourth dose of mRNA vaccine. The endpoints were infections and the combined incidence of ICU hospitalizations/death after the last dose (6-month survival rate). Among 268 patients, 62 had an infection, and 27.3% received four doses. Following multivariate analysis, three vs. four doses, mycophenolate (MMF) therapy, and HT < 5 years were associated with an increased risk of infection. MMF ≥ 2000 mg/day independently predicted infection, together with the other variables, and was associated with ICU hospitalization/death. Patients on MMF had lower levels of anti-RBD antibodies, and a positive antibody response after the third dose was associated with a lower probability of infection. In HT patients, a fourth dose of vaccine against SARS-CoV-2 reduces the risk of infection at six months. Mycophenolate, particularly at high doses, reduces the clinical effectiveness of the fourth dose and the antibody response to the vaccine. MDPI 2023-03-15 /pmc/articles/PMC10053932/ /pubmed/36985328 http://dx.doi.org/10.3390/microorganisms11030755 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Masetti, Marco
Scuppa, Maria Francesca
Aloisio, Alessio
Giovannini, Laura
Borgese, Laura
Manno, Stefania
Tazza, Beatrice
Pascale, Renato
Bonazzetti, Cecilia
Caroccia, Natascia
Sabatino, Mario
Spitaleri, Giosafat
Viale, Pierluigi
Giannella, Maddalena
Potena, Luciano
Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients
title Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients
title_full Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients
title_fullStr Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients
title_full_unstemmed Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients
title_short Effect of a Fourth Dose of mRNA Vaccine and of Immunosuppression in Preventing SARS-CoV-2 Breakthrough Infections in Heart Transplant Patients
title_sort effect of a fourth dose of mrna vaccine and of immunosuppression in preventing sars-cov-2 breakthrough infections in heart transplant patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053932/
https://www.ncbi.nlm.nih.gov/pubmed/36985328
http://dx.doi.org/10.3390/microorganisms11030755
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