Incidence and outcome of COVID-19 following vaccine and hybrid immunity in patients on immunosuppressive therapy: identification of protective post-immunisation anti-RBD antibody levels in a prospective cohort study
Authors' conclusion
Vaccinated patients with IMID have a low risk of severe COVID-19. Hybrid immunity lowers the risk of infection. High post-immunisation anti-RBD levels protect against COVID-19.
Study context
- Population
- Patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressives and healthy controls (HC) receiving SARS-CoV-2 vaccines, 15 February 2021 to 15 February 2023
- Participants
- 1,729 vs 350
- Exposure
- IMIDs on immunosuppressives vs HC receiving SARS-CoV-2 vaccines
- IMIDsn = 1,729
- HCn = 350reference
- Outcome
- Incidence, severity and predictors of COVID-19, incl. protective post-vaccination anti-RBD levels
Methodological detailsobservational, anti-RBD antibodies measured 2-5 weeks post-immunisation
- Observational
- anti-RBD antibodies measured 2-5 weeks post-immunisation
Main finding
As reported in the abstract
Incidence of COVID-19
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| COVID-19 risk by immunity typeVaccine-induced immunityvs hybrid immunity | 5.89 (4.45–7.80) | |
| 0.10.31310Hazard ratio (log scale) |
COVID-19 risk by post-immunisation anti-RBD level
| HR (95% CI) | ||
|---|---|---|
| anti-RBD levels <6000 binding antibody units/mLFollowing three doses | 1.37 (1.08–1.74) | |
| anti-RBD levels <6000 binding antibody units/mLFollowing four doses | 1.28 (1.02–1.62) | |
| 0.512Hazard ratio (log scale) |
COVID-19 re-infection by post-immunisation anti-RBD level
| HR (95% CI) | ||
|---|---|---|
| anti-RBD levels <6000 binding antibody units/mL | 4.47 (1.87–10.67) | |
| 0.050.21520Hazard ratio (log scale) |
COVID-19 re-infection
- Re-infection occurred in 12% of patients
COVID-19-related deaths
- No COVID-19-related deaths occurred
Safety
- Severe COVID-19 in 22 (2%) patients
- Severe COVID-19 in no HC
Original publication
Incidence and outcome of COVID-19 following vaccine and hybrid immunity in patients on immunosuppressive therapy: identification of protective post-immunisation anti-RBD antibody levels in a prospective cohort study. RMD Open. Published 9 April 2024. doi:10.
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