New research from NYU Grossman School of Medicine published in Arthritis & Rheumatology suggests that patients with systemic lupus erythematosus (SLE), commonly known as lupus, have lower responses to the COVID-19 vaccines than control groups. In a multi-ethnic/racial study of patients with SLE, 29 percent produced lower than normal IgG antibodies against the SARS-CoV-2 spike receptor-binding domain (RBD).

Peter M. Izmirly, MD, associate professor of medicine at NYU Grossman School of Medicine and renowned lupus researcher, led a team to observe 90 patients with SLE who received a full COVID-19 vaccination regimen. The study also showed that IgG seroreactivity to the SARS-CoV-2 spike RBD strongly correlated with a functional assay that measures the ability of post-vaccinated individuals’ plasma to neutralize infectious virus in cultured cells. Their group also assessed T cell response to the vaccine and showed that interferon gamma production was diminished in patients with low IgG antibodies against SARS-CoV-2.

“This supports previous data that has been coming out from our group and others that show patients on certain immunosuppression have a blunted effect to the COVID-19 vaccine,” Dr. Izmirly tells Healio Rheumatology. “This study focused on patients only with systemic lupus erythematosus and showed that a lower response to the vaccine was independently associated with being on any immunosuppressive agent, with the exception of antimalarials such as hydroxychloroquine.”

In addition, the study participants were assessed for vaccine-induced flares. Overall the proportion of patients who flared was low (11.4 percent), and severe SLE flares were rare (1.4 percent).

The results of this work are reassuring regarding the safety of initial vaccination and suggest further studies are needed to assess efficacy and safety of booster vaccination in patients with suboptimal responses to the standard vaccination regimen.

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