COVID-19 vaccines effective in most autoimmune patients on immunosuppressive drugs

After two doses of COVID-19 vaccine, most autoimmune patients treated with immunosuppressants develop an antibody response similar to controls. The production of antibodies seems to be reduced only in in patients treated with anti-CD20. This is what Laura Boekel of Reade and Maurice Steenhuis of Sanquin conclude from a of a large-scale corona study, now published in the Lancet Rheumatology

The researchers state however that delayed second dosing of COVID-19 vaccines should best be avoided in patients receiving immunosuppressive drugs, as those who receive methotrexate or anti-CD20 therapies produce fewer antibodies after an initial corona vaccination. 

The study started in April 2020 and includes over 3,000 participating patients from Reade and the Amsterdam UMC and over 1,000 healthy controls.

Serum samples were collected via regular blood withdrawal at the local research institutes or via a finger prick at home before and after receiving a COVID-19 vaccination. Analyses were done at Sanquin, using in-house tests. 

After two COVID-19 vaccine doses, seroconversion rates and IgG antibody titers were similar for patients across all treatment subgroups and healthy controls, except for patients treated with anti-CD20 therapies. In addition, seroconversion rates and IgG antibody titers were comparable between patients with a previous SARS-CoV-2 infection who had received a single vaccine dose and patients without a previous SARS-CoV-2 infection who had received two vaccine doses. 

Therefore, it seems that seroconversion after a first COVID-19 vaccination is delayed in patients on specific immunosuppressive drugs, but that second or repeated exposure to SARS-CoV-2, either via infection or vaccination, improves humoral immunity in patients treated with immunosuppressive drugs.

Again, the knowledge acquired by Sanquin Diagnostic Services and Research has been utilised to support innovative patient care.


Antibody development after COVID-19 vaccination in patients with autoimmune diseases in the Netherlands: a substudy of data from two prospective cohort studies.
Boekel L, Steenhuis M, Hooijberg F, Besten YR, van Kempen ZLE, Kummer LY, van Dam KPJ, Stalman EW, Vogelzang EH, Cristianawati O, Keijzer S, Vidarsson G, Voskuyl AE, Wieske L, Eftimov F, van Vollenhoven R, Kuijpers TW, van Ham SM, Tas SW, Killestein J, Boers M, Nurmohamed MT, Rispens T, Wolbink G. Lancet Rheumatol. 2021 Aug 6.