May 26, 2021 -- While doctors still highly recommend that they get vaccinated against COVID-19, as many as 1 in 10 people with auto-immune diseases such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease may fail to properly develop immunity against the pandemic virus, new research suggests.
Patients who take heavy-duty drugs known as methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo) and rituximab (Rituxan) appear to respond especially poorly, although the findings are still preliminary.
But patients with autoimmune disorders shouldn’t panic, rheumatologist Anne Bass, MD, of Weill Cornell Medicine In New York, said in an interview.
“These vaccines have now been used in millions of patients, and they’ve proven to be remarkable safe and remarkably effective,” she said. “Even if you have a reduction in your response because you have an auto-immune disease or you’re on these mediations, you’re still more likely to be protected against hospitalization and death than if you don’t get the vaccine at all.”
To find out, German researchers tracked two groups of people who COVID-19 vaccinations: 84 patients with conditions such as rheumatoid arthritis, inflammatory bowel disease, psoriasis and the kinds of arthritis known as spondylarthritis, and 182 healthy people.
The study findings appeared May 6 in the journal Annals of the Rheumatic Diseases.
All but one person in the healthy group developed “neutralizing” antibodies against COVID-19, a sign that the vaccines worked properly. But 10% of those with the immune conditions didn’t develop the antibodies. On the other hand, patients with the conditions had fewer vaccine-related side effects. There is good news: The findings “reiterate that vaccinations are safe and effective,” co-author Georg Schett, MD, of Germany’s Friedrich-Alexander University Erlangen-Nuremberg and University Hospital Erlangen, said in an interview.
Another pair of studies, also published in Annals of the Rheumatic Diseases, examine the possible effects of methotrexate and rituximab on patients who get vaccinated against COVID-19. Both drugs dampen the immune system to stop the body from attacking itself.
In a study published May 25, researchers examined vaccine response in three groups of people from New York City and Erlangen, Germany. The researchers found that two groups responded well to the COVID-19 vaccine, with more than 90% showing a “robust” response: 208 healthy people and 37 people with immune disorders, mostly taking “biologic” drugs. But only 62% of immune disorder patients who took methotrexate reached an “adequate response.”
What’s going on? Researcher Schett, who also co-authored this study, said the explanation may lie in the overactivity of the immune system in patients with diseases like rheumatoid arthritis. Vaccines prepare the immune system to respond to COVID-19 germs. But in some of these patients, he said, certain parts of the immune system may just be exhausted from overactivity. “In addition, specific drugs such as methotrexate could additionally impair the immune response,” he said.
For another study, published May 11, U.S. researchers tracked 89 patients at a single rheumatology clinic who’d received at least one dose of a COVID-19 vaccine. Of those, 21 patients showed no sign of vaccine antibody response; 20 of them were taking rituximab. The other patient was taking a drug called belimumab (Benlysta). However, another 10 patients taking rituximab did show a response.
What should be done to protect patients who may not respond properly to COVID-19 vaccines? Schett, the researcher in Germany, said that “testing immune response to vaccination is important for patients with autoimmune disease.” (This kind of testing determines if the immune system is prepared to respond properly to the COVID-19 virus.) He added that “some of them may need a third vaccination.”
The American College of Rheumatology’s COVID-19 vaccination guidelines do not recommend third vaccinations or immune testing after vaccination at this time. But Bass, who co-wrote the guidelines, said it’s likely that post-vaccine immune testing and booster shots will become routine.