Spondyloarthritis & psoriatic arthritis
Interaction of TNF inhibitors (TNFi) and conventional synthetic DMARD in SARS-CoV-2 vaccine response in axial spondyloarthritis and psoriatic arthritis
Authors' conclusion
We provided novel data demonstrating that TNFi attenuates immunogenicity in SpA patients while SSZ has a positive impact on vaccine antibody production.
Study context
- Population
- Patients with axSpA/PsA receiving inactivated SARS-CoV-2 vaccine (CoronaVac) in 2 doses 28 days apart with booster at day 210194 spondyloarthritis (SpA) patients enrolled
- Participants
- 183 vs 183
- Exposure
- SpA patients vs age/sex-balanced controls after 3 doses of CoronaVac
- SpAn = 183
- Control group (CG)n = 183reference
- Outcome
- Anti-SARS-CoV-2 IgG seropositivity (SP) and neutralising antibodies (NAb)
- Follow-up
- D69
Methodological detailsage/sex-balanced control group, nested in CoronavRheum phase 4 trial
- Age/sex-balanced control group
- Nested in CoronavRheum phase 4 trial
Main finding
As reported in the abstract
Anti-SARS-CoV-2 IgG SP
P < 0.001
Observational data: associations, not effects.
Further findings
NAb positivity · D69
P < 0.001
| Outcome | P value |
|---|---|
| SSZ monotherapy vs CG · D69SSZ monotherapy vs CG | P > 0.999 |
| SSZ monotherapy vs CG · D69SSZ monotherapy vs CG | P > 0.999 |
- SSZ+TNFi combination vs CG: similar response · D69
- P = 0.153
- SSZ+TNFi combination vs CG: similar response · D69
- P = 0.715
- SSZ monotherapy vs CG: SSZ monotherapy 100% · neutralising antibodies (NAb) positivity 83.3%
Factors independently associated with lower seropositivity (SP) in SpA patients · D69
- Older age, prednisone (P<0.001), methotrexate (MTX) (P<0.001) and TNFi (P<0.001) associated with lower SP
- Caucasian ethnicity (P<0.05) and prednisone (P<0.01) associated with diminished NAb
- SSZ use associated with NAb presence (P<0.05)
- In monotherapy, only TNFi associated with absence of SP (P<0.05)
- Vs CG, TNFi and/or MTX negatively impacted SP/NAb (P<0.05)
After third dose (D69 to D240), SpA patients: SP and NAb increment
- SP 81.3% to 93.1% (P<0.001)
- NAb 63.2% to 86.1% (P<0.001)
- Still lower than CG (P<0.05)
- Only TNFi impaired SP (P=0.016) and NAb (P=0.002)
Original publication
Interaction of TNFi and conventional synthetic DMARD in SARS-CoV-2 vaccine response in axial spondyloarthritis and psoriatic arthritis. Joint Bone Spine. Published 20 September 2022. doi:10.
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