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Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine
Objectives: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. Methods: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifes...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675674/ https://www.ncbi.nlm.nih.gov/pubmed/38006015 http://dx.doi.org/10.3390/vaccines11111684 |
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author | Picchianti-Diamanti, Andrea Navarra, Assunta Aiello, Alessandra Laganà, Bruno Cuzzi, Gilda Salmi, Andrea Vanini, Valentina Maggi, Fabrizio Meschi, Silvia Matusali, Giulia Notari, Stefania Agrati, Chiara Salemi, Simonetta Di Rosa, Roberta Passarini, Damiano Di Gioia, Valeria Sesti, Giorgio Conti, Fabrizio Spinelli, Francesca Romana Corpolongo, Angela Chimenti, Maria Sole Ferraioli, Mario Sebastiani, Gian Domenico Benucci, Maurizio Li Gobbi, Francesca Santoro, Anna Paola Capri, Andrea Puro, Vincenzo Nicastri, Emanuele Goletti, Delia |
author_facet | Picchianti-Diamanti, Andrea Navarra, Assunta Aiello, Alessandra Laganà, Bruno Cuzzi, Gilda Salmi, Andrea Vanini, Valentina Maggi, Fabrizio Meschi, Silvia Matusali, Giulia Notari, Stefania Agrati, Chiara Salemi, Simonetta Di Rosa, Roberta Passarini, Damiano Di Gioia, Valeria Sesti, Giorgio Conti, Fabrizio Spinelli, Francesca Romana Corpolongo, Angela Chimenti, Maria Sole Ferraioli, Mario Sebastiani, Gian Domenico Benucci, Maurizio Li Gobbi, Francesca Santoro, Anna Paola Capri, Andrea Puro, Vincenzo Nicastri, Emanuele Goletti, Delia |
author_sort | Picchianti-Diamanti, Andrea |
collection | PubMed |
description | Objectives: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. Methods: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifestyle and demographic factors were collected at the time of the third dose, and immunogenicity analyses were carried out in a subgroup of patients at 4–6 weeks after the third dose. Results: BIs were experienced by 42% patients (82/194) with a median time since the last vaccination of 176 days. Older age (>50 years; aHR 0.38, 95% CI: 0.20–0.74), receiving conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (aHR 0.52, 95%CI: 0.30–0.90) and having a titre of neutralising antibodies >20 (aHR 0.36, 95% CI: 0.12–1.07) were identified as protective factors. Conversely, anti-IL6R treatment and anti-CD20 therapy increased BI probability. BIs were mostly pauci-symptomatic, but the hospitalisation incidence was significantly higher than in HCWs (8.5% vs. 0.19%); the main risk factor was anti-CD20 therapy. Conclusions: Being older than 50 years and receiving csDMARDs were shown to be protective factors for BI, whereas anti-IL6R or anti-CD20 therapy increased the risk. Higher neutralising antibody titres were associated with a lower probability of BI. If confirmed in a larger population, the identification of a protective cut-off would allow a personalised risk–benefit therapeutic management of RA patients. |
format | Online Article Text |
id | pubmed-10675674 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-106756742023-11-02 Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine Picchianti-Diamanti, Andrea Navarra, Assunta Aiello, Alessandra Laganà, Bruno Cuzzi, Gilda Salmi, Andrea Vanini, Valentina Maggi, Fabrizio Meschi, Silvia Matusali, Giulia Notari, Stefania Agrati, Chiara Salemi, Simonetta Di Rosa, Roberta Passarini, Damiano Di Gioia, Valeria Sesti, Giorgio Conti, Fabrizio Spinelli, Francesca Romana Corpolongo, Angela Chimenti, Maria Sole Ferraioli, Mario Sebastiani, Gian Domenico Benucci, Maurizio Li Gobbi, Francesca Santoro, Anna Paola Capri, Andrea Puro, Vincenzo Nicastri, Emanuele Goletti, Delia Vaccines (Basel) Article Objectives: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. Methods: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifestyle and demographic factors were collected at the time of the third dose, and immunogenicity analyses were carried out in a subgroup of patients at 4–6 weeks after the third dose. Results: BIs were experienced by 42% patients (82/194) with a median time since the last vaccination of 176 days. Older age (>50 years; aHR 0.38, 95% CI: 0.20–0.74), receiving conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (aHR 0.52, 95%CI: 0.30–0.90) and having a titre of neutralising antibodies >20 (aHR 0.36, 95% CI: 0.12–1.07) were identified as protective factors. Conversely, anti-IL6R treatment and anti-CD20 therapy increased BI probability. BIs were mostly pauci-symptomatic, but the hospitalisation incidence was significantly higher than in HCWs (8.5% vs. 0.19%); the main risk factor was anti-CD20 therapy. Conclusions: Being older than 50 years and receiving csDMARDs were shown to be protective factors for BI, whereas anti-IL6R or anti-CD20 therapy increased the risk. Higher neutralising antibody titres were associated with a lower probability of BI. If confirmed in a larger population, the identification of a protective cut-off would allow a personalised risk–benefit therapeutic management of RA patients. MDPI 2023-11-02 /pmc/articles/PMC10675674/ /pubmed/38006015 http://dx.doi.org/10.3390/vaccines11111684 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 Picchianti-Diamanti, Andrea Navarra, Assunta Aiello, Alessandra Laganà, Bruno Cuzzi, Gilda Salmi, Andrea Vanini, Valentina Maggi, Fabrizio Meschi, Silvia Matusali, Giulia Notari, Stefania Agrati, Chiara Salemi, Simonetta Di Rosa, Roberta Passarini, Damiano Di Gioia, Valeria Sesti, Giorgio Conti, Fabrizio Spinelli, Francesca Romana Corpolongo, Angela Chimenti, Maria Sole Ferraioli, Mario Sebastiani, Gian Domenico Benucci, Maurizio Li Gobbi, Francesca Santoro, Anna Paola Capri, Andrea Puro, Vincenzo Nicastri, Emanuele Goletti, Delia Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
title | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
title_full | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
title_fullStr | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
title_full_unstemmed | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
title_short | Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine |
title_sort | older age, a high titre of neutralising antibodies and therapy with conventional dmards are associated with protection from breakthrough infection in rheumatoid arthritis patients after the booster dose of anti-sars-cov-2 vaccine |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675674/ https://www.ncbi.nlm.nih.gov/pubmed/38006015 http://dx.doi.org/10.3390/vaccines11111684 |
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