COVID-19 vaccination responses in people with vasculitis [COVID-19]
Research type
Research Study
Full title
Do people with vasculitis and other autoimmune rheumatic diseases mount an effective response to COVID-19 vaccination, and how long does it last for?
IRAS ID
295772
Contact name
Lucy Fairclough
Contact email
Sponsor organisation
University of Nottingham
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Research Summary:
People with vasculitis and other autoimmune rheumatic diseases may not develop as effective or long-lasting a response to COVID-19 vaccination as healthy people of a similar age. This means people with vasculitis may be less well protected following vaccination, and perhaps require more frequent booster doses of vaccination than healthy people.
We plan to test the response to vaccination in 50 people with vasculitis (and compare this to the response to vaccination in 50 people of a similar age from the general population recruited as part of a related study). We will recruit people with vasculitis from the large number of people with vasculitis who attend the rheumatology & renal departments in Nottingham for their healthcare. All patients will receive their vaccine as they usually would (when they are invited in their priority group). This study involves asking people to give blood samples to test their response to vaccination – both before and after vaccination.
Research has shown that there are two key components to the immune system response that protect against COVID-19 infection – these are levels of protective antibodies, and numbers of protective memory T-cells produced. The protective T-cell response may be particularly important in people who have been treated with Rituximab, because Rituximab directly affects the cells which make antibodies. We will measure both types of responses using tests already developed and working in the immunology labs in Nottingham.
We will take blood samples for analysis just before vaccination, 1, 3, 6 & 12 months after vaccination. This will allow us to measure how effective the response to vaccination is among people with vasculitis, and how long it lasts. We will see whether particular treatments (e.g. steroids, or rituximab) affect the response to vaccination.
Summary of Results:
People living with rare autoimmune rheumatic diseases (such as vasculitis, lupus and myositis) often have weakened immune systems because of their condition or the medicines used to treat it. This means they may not respond to vaccinations, including COVID-19 vaccines, in the same way as healthy people. This study aimed to understand how well people with these conditions responded to COVID-19 vaccination, and which factors affected that response.
50 people with rare autoimmune rheumatic diseases took part in this study. Participants provided information about their diagnosis, treatments, age, sex, ethnic background, and COVID-19 vaccination history. Blood samples were taken after vaccination to measure immune responses. These results were compared with those from healthy people.
The first report of results looked at immune responses after two doses of COVID-19 vaccine. Most participants produced lower levels of protective antibodies than healthy people, and some produced none at all. We also studied another important part of the immune system called T cells, which help the body recognise and fight infections. People with low or no antibody responses also had fewer and poorer-quality T cells, meaning their immune protection was weaker overall. Recent treatment with a medicine called rituximab (within the previous 12 months) was strongly linked to poorer vaccine responses.
The second report of the results looked at immune responses after booster doses of the COVID-19 vaccine (third or fourth doses). This showed that additional vaccine doses improved immune responses. While fewer than half of participants had protective antibody levels after two doses, this increased after booster doses, with about two-thirds producing enough antibodies after a fourth dose. However, people who had received rituximab in the previous year, and those from non-White ethnic backgrounds, were less likely to develop strong antibody responses.
Overall, these studies show that people with rare autoimmune rheumatic diseases often have weaker immune responses to COVID-19 vaccination, but that booster doses can improve protection for many people. The findings help explain why some patients remain vulnerable to infection and highlight the importance of tailored vaccination strategies for people with these conditions.
The results of this research were published in Rheumatology in 2022 and Rheumatology Advances in Practice in 2023.
REC name
West Midlands - Black Country Research Ethics Committee
REC reference
21/WM/0097
Date of REC Opinion
30 Mar 2021
REC opinion
Favourable Opinion