Comparison of the Serial Humoral Immune Response according to the Immunosuppressive Treatment after SARS-CoV-2 mRNA Vaccination

Hiroya Menjo; Midori Hasegawa; Hidetsugu Fujigaki; Takuma Ishihara; Shun Minatoguchi; Shigehisa Koide; Hiroki Hayashi; Midori Saito; Kazuo Takahashi; Hiroyasu Ito; Yukio Yuzawa; Kuniaki Saito; Naotake Tsuboi

doi:10.2169/internalmedicine.1949-23

ORIGINAL ARTICLES

Comparison of the Serial Humoral Immune Response according to the Immunosuppressive Treatment after SARS-CoV-2 mRNA Vaccination

Hiroya Menjo, Midori Hasegawa, Hidetsugu Fujigaki, Takuma Ishihara, Shun Minatoguchi, Shigehisa Koide, Hiroki Hayashi, Midori Saito, Kazuo Takahashi, Hiroyasu Ito, Yukio Yuzawa, Kuniaki Saito, Naotake Tsuboi

Author information

Hiroya Menjo
Department of Nephrology, Fujita Health University School of Medicine, Japan
Midori Hasegawa
Department of Nephrology, Fujita Health University School of Medicine, Japan
Hidetsugu Fujigaki
Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Japan
Takuma Ishihara
Gifu University Hospital Innovative and Clinical Research Promotion Center, Japan
Shun Minatoguchi
Department of Nephrology, Fujita Health University School of Medicine, Japan
Shigehisa Koide
Department of Nephrology, Fujita Health University School of Medicine, Japan
Hiroki Hayashi
Department of Nephrology, Fujita Health University School of Medicine, Japan
Midori Saito
Laboratory of Clinical Medicine, Fujita Health University Hospital, Japan
Kazuo Takahashi
Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine, Japan
Hiroyasu Ito
Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Japan
Yukio Yuzawa
Department of Nephrology, Fujita Health University School of Medicine, Japan
Kuniaki Saito
Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Japan
Naotake Tsuboi
Department of Nephrology, Fujita Health University School of Medicine, Japan

Keywords: COVID-19, glucocorticoid, humoral immune response, immunosuppressive treatment, kidney disease, vaccination

JOURNAL OPEN ACCESS
Supplementary material

2023 Volume 62 Issue 23 Pages 3445-3454

DOI https://doi.org/10.2169/internalmedicine.1949-23

Browse “Advance online publication” version

Details

Abstract

Objective The objective of this study was to estimate the humoral immune response evaluated by immunoglobulin G (IgG) against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD-IgG) following the third mRNA coronavirus disease 2019 (COVID-19) vaccination in patients with kidney disease who received immunosuppressive treatment.

Methods The primary outcome was RBD-IgG levels after the third SARS-CoV-2 vaccination. The primary comparison was the RBD-IgG levels between patients with kidney disease who received immunosuppressive treatment (n=124) and those who did not (n=33).

Results The RBD-IgG levels were significantly lower in the patients with kidney disease who received immunosuppressive treatment than in those who did not receive immunosuppressive treatment. The RBD-IgG levels were lower in patients treated with glucocorticoid monotherapy than in those who did not receive immunosuppressive treatment. Even in patients who received ≤5 mg prednisolone, the RBD-IgG levels were significantly lower. Nine of the 10 patients who received rituximab within one year before the first vaccination did not experience seroconversion after the third vaccination. Meanwhile, all nine patients who received rituximab only after the second vaccination experienced seroconversion, even if B cell recovery was insufficient. Patients treated with mycophenolate mofetil plus glucocorticoid plus belimumab had significantly lower RBD-IgG levels than those treated with mycophenolate mofetil plus glucocorticoid.

Conclusion The RBD-IgG levels were lower in patients with kidney disease who received immunosuppressive treatment than in those who did not receive immunosuppressive treatment. Low-dose glucocorticoid monotherapy affected the humoral immune response following the third mRNA COVID-19 vaccination.

Corresponding author

Register with J-STAGE for free!