Immunogenicity of COVID-19 Vaccines in Autoimmune Rheumatic Diseases
Summary
Patients with autoimmune rheumatic diseases exhibit variable immune responses to COVID-19 vaccination owing to underlying immune dysregulation and immunosuppressive therapies. Humoral immunogenicity, reflected by antibody titres and neutralising capacity, may be attenuated by agents such as B-cell depleters, antimetabolites and co-stimulation blockers. Cellular immunogenicity, assessed via T-cell proliferation and cytokine release, often remains more resilient but can be impaired under specific regimens. Breakthrough infections have underscored the need to balance disease control with optimal vaccine timing, while booster doses appear to restore waning humoral responses in many patient subsets. Practical management strategies now incorporate tailored vaccine schedules, temporary immunosuppressant suspension and close monitoring of serological and cellular markers to maximise protection without provoking disease flares.
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Immunogenicity of COVID-19 Vaccines in Autoimmune Rheumatic Diseases publication trend
The graph below shows the total number of articles in immunogenicity of covid-19 vaccines in autoimmune rheumatic diseases across all publications each year (not limited to Nature Index journals).
Technical terms
Immunogenicity: The capacity of a vaccine to elicit an immune response, including antibody production and T-cell activation.
Humoral immunity: Antibody-mediated defence against pathogens, primarily driven by B lymphocytes and circulating immunoglobulins.
Cellular immunity: T-cell-mediated immune response characterised by cytokine secretion and cytotoxic activity against infected cells.
Rituximab: A monoclonal antibody targeting CD20 on B cells, often leading to prolonged B-cell depletion and diminished antibody production.
Breakthrough infection: Occurrence of infection despite complete vaccination, indicative of reduced vaccine efficacy or immune evasion by viral variants.
References
- Breakthrough SARS-CoV-2 infections and prediction of moderate-to-severe outcomes during rituximab therapy in patients with rheumatic and musculoskeletal diseases in the UK: a single-centre cohort study. The Lancet Rheumatology (2023).
- Clinical and humoral response after SARS-CoV-2 breakthrough infection in patients receiving immunosuppressant therapy. Journal of Allergy and Clinical Immunology (2024).
- Efficacy of COVID-19 mRNA vaccination in patients with autoimmune disorders: humoral and cellular immune response. BMC Medicine (2023).
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