1. CoronaVac, an inactivated SARS-CoV-2 vaccine, offers reduced but adequate short-term immunogenicity among people with autoimmune rheumatic diseases.
Evidence Rating Level: 2 (Good)
In the context of an ongoing COVID-19 pandemic, several vaccines have been approved for emergency use in the hope of reducing the spread of infection. Several countries have approved CoronaVac, an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Similar to some other vaccines, immunogenicity is largely unclear as it relates to specific populations of people. Specifically, this study sought to investigate the immunogenicity of CoronaVac among adults with autoimmune rheumatic diseases (ARD). Excluded individuals included those with acute febrile illness or symptoms, demyelinating disease, positive baseline IgG serology, and previous COVID-19 vaccination. This prospective, phase 4 trial included 910 adults with ARD and 182 sex- and age-frequency-matched healthy controls (CG), both groups receiving two doses of CoronaVac. Median ages were not significantly different between groups (51 vs. 50 years, p = .985) nor was the number of female participants (76.9% vs. 76.9%, p>.999). The most common ARD diagnoses were chronic inflammatory arthritis (CIA; 49.6%), rheumatoid arthritis (RA; 28.1%), axial spondyloarthritis (axSpA; 11.6%), psoriatic arthritis (PsA; 9.8%), systemic lupus erythematosus (SLE; 25.5%), and primary vasculitis (7.3%). The ARD group had a significantly high frequency of comorbidities, such as systematic arterial hypertension (difference 13.8%, p = .001), dyslipidemia (difference 12.3%, p<.001), interstitial lung disease (difference 8.6%, p<.001), cardiomyopathy (difference 4.1%, p = .024), and chronic renal disease (difference 4.8%, p = .001). At Day 28, ARD group had lower IgG frequency (difference -15.9%, p<.001) and NAb positivity (difference -15.7, p<.001) than the CG. At Day 69, lower Nab positivity (difference -23.0, p<.001) and anti-SARS-CoV-2 IgG SC (-25.1, p<.001) were found in the ARD group than the CG. Median neutralization activity (difference -5.8, p = .013) and IgG titers (difference -17.6, p<.001) were also lower in ARD group at Day 69, compared to the CG. Overall, this phase 4 trial suggests that CoronaVac use among ARD patients results in reduced but adequate short-term immunogenicity. Long-term effectiveness of CoronaVac is still being studied.
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