Absent Antibody Production Following COVID19 Vaccination with mRNA in Patients Under Immunosuppressive Treatments

Patients undergoing immunosuppressive treatments have a higher need for protection against coronavirus disease (COVID19) that follows infection with the SARS-CoV-2 virus but their ability to respond sufficiently to COVID vaccines is uncertain. We retrospectively evaluated SARS-CoV-2 spike subunit 1 (S1)-specific antibody levels after two mRNA doses in 242 patients with underlying chronic inflammatory, hematooncological or metabolic diseases and in solid organ transplant recipients. S1-specific antibodies were measured 30 days after the second dose. In 15.9% of these patients, no S1-specific antibodies were detectable. Non-responsiveness was linked to administration of B-cell depleting therapies as well as to ongoing therapies that block lymphocyte trafficking (Fingolimod) or inhibit T cell proliferation (Tacrolimus). Thus, it is important to inform immunosuppressed patients about the risk of vaccine non-responsiveness and the necessity to maintain non-pharmaceutical protection measures. In these risk patients antibody testing and cellular analysis are helpful to estimate the benefit/responsiveness to further booster vaccinations.