Vaccination effective in spite of immune disease

Rheumatism, inflammatory bowel disease and psoriasis are examples of diseases which trigger a false, excessive immune reaction and which require treatment with anti-inflammatory drugs. Researchers from the German Centre for Immunotherapy (DZI; spokespersons: Prof. Dr. Markus F. Neurath and Prof. Dr. med.univ. Georg Schett) at Universitätsklinikum Erlangen, have investigated how well these patients respond to a coronavirus vaccine. Their study is one of the first in the world to explore this topic and provide results. The study has now been published in the journal ‘Annals of the Rheumatic Diseases’.

Good news first: the coronavirus vaccine is even better tolerated by patients with chronic inflammatory diseases than by healthy people. Side effects such as pain at the injection site, headaches, chills and joint pain occurred considerably less often than in healthy people. With this study, the researchers have been able to disprove the rumour that the altered immune system of patients with rheumatism, inflammatory bowel disease and psoriasis may cause them to experience an excessive immune reaction in response to the coronavirus vaccination. In a nutshell: There is no reason to avoid vaccinating individuals with chronic inflammatory diseases against Covid-19.

The slightly less positive news is that not all patients with inflammatory diseases respond adequately by developing immunity to SARS-CoV-2 after receiving an mRNA vaccine. Whilst only one in a hundred healthy people failed to develop neutralising antibodies against coronavirus in a group of approximately 270 test persons, this rose to 1 in 10 in patients undergoing immune therapy. It also follows, however, that the majority of patients with chronic inflammatory diseases do respond well to the vaccine. Interestingly, it appears that it is not the anti-inflammatory treatment which is behind the failure of certain patients to react to the vaccine, but rather the disease itself. There is therefore no reason to temporarily stop taking medication before receiving the vaccine, according to the lead authors of the study.

‘Not everyone reacts in the same way,’ says PD Dr. David Simon, junior physician at Department of Medicine 3 – Rheumatology and Immunology (director: Prof. Dr. med.univ. Georg Schett) at Universitätsklinikum Erlangen. ‘It therefore makes sense to check the immune response in patients with chronic inflammatory diseases two weeks after the second vaccine.’ If they have not responded correctly, there are several options which can be pursued, but the most effective would appear to be another vaccination, ideally using a different vaccine from the one originally given. Whilst it is crucial that we stick strictly to a vaccination regime at the current time in order to curb the spread of the pandemic, in future it will be necessary to adjust the vaccination strategy in certain individual cases, giving another (third) vaccination, or changing the vaccine used.

The study was conducted at the German Centre for Immunotherapy at Universitätsklinikum Erlangen directed by Prof. Dr. med. univ. Georg Schett (director of Department of Medicine 3 – Rheumatology and Immunology), Prof. Dr. Markus F. Neurath (director of Department of Medicine 1- Gastroenterology, Pneumology and Endocrinology), Prof. Dr. Carola Berking and Prof. Dr. Michael Sticherling (director and vice director of the Department of Dermatology respectively). The researchers received funding from the Free State of Bavaria, the Schreiber Foundation and the German Research Foundation (Collaborative Research Centre 1181).

Original article: https://dx.doi.org/10.1136/annrheumdis-2021-220461

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