TY - JOUR
T1 - Impact of immunosuppressive treatment and type of SARS-CoV-2 vaccine on antibody levels after three vaccinations in patients with chronic kidney disease or kidney replacement therapy
AU - Bouwmans, Pim
AU - Messchendorp, A. Lianne
AU - Imhof, Céline
AU - Sanders, Jan Stephan F.
AU - Hilbrands, Luuk B.
AU - Reinders, Marlies E.J.
AU - Vart, Priya
AU - Bemelman, Frederike J.
AU - Abrahams, Alferso C.
AU - van den Dorpel, René M.A.
AU - Ten Dam, Marc A.G.J.
AU - de Vries, Aiko P.J.
AU - Rispens, Theo
AU - Steenhuis, Maurice
AU - Gansevoort, Ron T.
AU - Hemmelder, Marc H.
AU - ter Meulen, Rik C.G.
AU - Cheng, Jennifer
AU - Konings, Constantijn J.A.M.
AU - Peters, Vincent J.P.
AU - Remmerswaal, Ester B.M.
AU - Frölke, Sophie C.
AU - Rots, Nynke
AU - van der Klis, Fiona
AU - Konijn, Wanda S.
AU - de Ronde, Anthony
AU - Vervoort, Hanneke J.P.M.
AU - Braks, Marion H.J.
AU - Kho, Marcia L.
AU - Baan, Carla C.
AU - Malaha, Reshwan S.R.K.
AU - Janssen, Wilbert M.T.
AU - Til, Erik
AU - Zwerink, M.
AU - Brinkman, J. Niels
AU - Siegert, Carl
AU - Fritsen, Hein R.
AU - den Biggelaar, L.
AU - Bos, Willem Jan
AU - Willems, Manou
AU - van der Molen, Renate G.
AU - Diavatopoulos, Dimitri A.
AU - van Baarle, Debbie
N1 - Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
PY - 2023/3
Y1 - 2023/3
N2 - Background. Patients with chronic kidney disease (CKD) or kidney replacement therapy demonstrate lower antibody levels after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination compared with healthy controls. In a prospective cohort, we analysed the impact of immunosuppressive treatment and type of vaccine on antibody levels after three SARS-CoV-2 vaccinations. Methods. Control subjects (n = 186), patients with CKD G4/5 (n = 400), dialysis patients (n = 480) and kidney transplant recipients (KTR) (n = 2468) were vaccinated with either mRNA-1273 (Moderna), BNT162b2 (Pfizer-BioNTech) or AZD1222 (Oxford/AstraZeneca) in the Dutch SARS-CoV-2 vaccination programme. Third vaccination data were available in a subgroup of patients (n = 1829). Blood samples and questionnaires were obtained 1 month after the second and third vaccination. Primary endpoint was the antibody level in relation to immunosuppressive treatment and type of vaccine. Secondary endpoint was occurrence of adverse events after vaccination. Results. Antibody levels after two and three vaccinations were lower in patients with CKD G4/5 and dialysis patients with immunosuppressive treatment compared with patients without immunosuppressive treatment. After two vaccinations, we observed lower antibody levels in KTR using mycophenolate mofetil (MMF) compared with KTR not using MMF [20 binding antibody unit (BAU)/mL (3-113) vs 340 BAU/mL (50-1492), P < .001]. Seroconversion was observed in 35% of KTR using MMF, compared with 75% of KTR not using MMF. Of the KTR who used MMF and did not seroconvert, eventually 46% seroconverted after a third vaccination. mRNA-1273 induces higher antibody levels as well as a higher frequency of adverse events compared with BNT162b2 in all patient groups. Conclusions. Immunosuppressive treatment adversely affects the antibody levels after SARS-CoV-2 vaccination in patients with CKD G4/5, dialysis patients and KTR. mRNA-1273 vaccine induces a higher antibody level and higher frequency of adverse events.
AB - Background. Patients with chronic kidney disease (CKD) or kidney replacement therapy demonstrate lower antibody levels after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination compared with healthy controls. In a prospective cohort, we analysed the impact of immunosuppressive treatment and type of vaccine on antibody levels after three SARS-CoV-2 vaccinations. Methods. Control subjects (n = 186), patients with CKD G4/5 (n = 400), dialysis patients (n = 480) and kidney transplant recipients (KTR) (n = 2468) were vaccinated with either mRNA-1273 (Moderna), BNT162b2 (Pfizer-BioNTech) or AZD1222 (Oxford/AstraZeneca) in the Dutch SARS-CoV-2 vaccination programme. Third vaccination data were available in a subgroup of patients (n = 1829). Blood samples and questionnaires were obtained 1 month after the second and third vaccination. Primary endpoint was the antibody level in relation to immunosuppressive treatment and type of vaccine. Secondary endpoint was occurrence of adverse events after vaccination. Results. Antibody levels after two and three vaccinations were lower in patients with CKD G4/5 and dialysis patients with immunosuppressive treatment compared with patients without immunosuppressive treatment. After two vaccinations, we observed lower antibody levels in KTR using mycophenolate mofetil (MMF) compared with KTR not using MMF [20 binding antibody unit (BAU)/mL (3-113) vs 340 BAU/mL (50-1492), P < .001]. Seroconversion was observed in 35% of KTR using MMF, compared with 75% of KTR not using MMF. Of the KTR who used MMF and did not seroconvert, eventually 46% seroconverted after a third vaccination. mRNA-1273 induces higher antibody levels as well as a higher frequency of adverse events compared with BNT162b2 in all patient groups. Conclusions. Immunosuppressive treatment adversely affects the antibody levels after SARS-CoV-2 vaccination in patients with CKD G4/5, dialysis patients and KTR. mRNA-1273 vaccine induces a higher antibody level and higher frequency of adverse events.
KW - antibody response
KW - chronic kidney disease
KW - dialysis
KW - kidney transplantation
KW - SARS-CoV-2 vaccination
UR - http://www.scopus.com/inward/record.url?scp=85192080856&partnerID=8YFLogxK
U2 - 10.1093/ckj/sfac249
DO - 10.1093/ckj/sfac249
M3 - Article
AN - SCOPUS:85192080856
SN - 2048-8505
VL - 16
SP - 528
EP - 540
JO - Clinical Kidney Journal
JF - Clinical Kidney Journal
IS - 3
ER -