Waning humoral and cellular immunity after COVID-19 vaccination in patients with psoriasis treated with methotrexate and biologics: a cohort study

Amanda Kvist-Hansen*, Laura Pérez-Alós, Rownaq Fares Al-Sofi, Line Dam Heftdal, Sebastian Rask Hamm, Dina Leth Møller, Mia Marie Pries-Heje, Kamille Fogh, Cecilie Bo Hansen, Rasmus Bo Hasselbalch, Johannes Roth Madsen, Jose Juan Almagro Armenteros, Ruth Frikke-Schmidt, Linda Hilsted, Erik Sørensen, Sisse Rye Ostrowski, Henning Bundgaard, Susanne Dam Nielsen, Kasper Iversen, Claus ZachariaePeter Garred, Lone Skov

*Corresponding author af dette arbejde

Abstract

BACKGROUND: mRNA-based COVID-19 vaccines have short- and long-term efficacy in healthy individuals, but their efficacy in patients with psoriasis receiving immunomodulatory therapy is less studied.

OBJECTIVES: To investigate long-term immunity after COVID-19 vaccination in patients with psoriasis receiving immunomodulatory therapy.

METHODS: A prospective cohort study including patients (n = 123) with psoriasis receiving methotrexate (MTX) or biologics and controls (n = 226). Only mRNA-based COVID-19 vaccines administered with standard intervals between doses were investigated. Markers of immunity included SARS-CoV-2 spike glycoprotein-specific IgG and IgA, neutralizing capacity, and interferon-γ release from T cells stimulated with peptides of the SARS-CoV-2 spike glycoprotein.

RESULTS: The proportion of IgG responders was lower 6 months after vaccination in patients receiving anti-tumour necrosis factor (TNF) treatment compared with controls. Anti-TNF treatment was associated with lower IgG levels (β = -0.82, 95% confidence interval -1.38 to -0.25; P = 0.001). The median neutralizing index was lower in the anti-TNF group [50% inhibition (interquartile range [IQR] 37-89)] compared with controls [98% inhibition (IQR 96-99)]; P < 0.001. Cellular responses were numerically lowest in the anti-TNF group.

CONCLUSIONS: Treatment with anti-TNF has an impact on the immunity elicited by mRNA-based COVID-19 vaccination in patients with psoriasis, resulting in a faster waning of humoral and cellular markers of immunity; however, the clinical implications are unknown.

OriginalsprogEngelsk
TidsskriftBritish Journal of Dermatology
Vol/bind188
Udgave nummer5
Sider (fra-til)661-669
Antal sider9
ISSN0007-0963
DOI
StatusUdgivet - 20 apr. 2023

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