(HealthDay News) — About 1 in 5 immunosuppressed individuals have no detectable immunoglobulin (Ig)G anti-spike antibodies after 3 or more COVID-19 vaccinations, according to a study published in The Lancet Rheumatology.

Researchers examined the association between seropositivity to the SARS-CoV-2 spike protein and demographic, disease, and treatment-related characteristics after at least 3 COVID-19 vaccines in immunosuppressed patients.

The cohort included 23,036 patients with serological data, including 6593 with lymphoid malignancies, 9927 solid organ transplant recipients, and 6516 with rare autoimmune rheumatic diseases.

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Most patients (61.8%) had received 4 vaccine doses, 28.6% had received 3 doses, and 9.6% had received 5 or more doses. Previous SARS-CoV-2 infection was reported in 25.7% of patients with lymphoid malignancies, 31.4% of solid organ transplant recipients, and 29.5% of patients with rare autoimmune rheumatic diseases.

IgG anti-spike antibodies were undetectable in 20.7% of patients with lymphoid malignancies, 23.3% of patients with solid organ transplants, and 14.1% of those with rare autoimmune rheumatic diseases.

Seropositivity was associated with younger age, a higher number of vaccine doses, and previous COVID-19 in all groups. The likelihood of seropositivity was reduced with immunosuppressive medication.

Among the patients with lymphoid malignancies, factors associated with a negative antibody response included:

  • Older age (odds ratio [OR] for every 10-year increase, 0.76; 95% CI, 0.71–0.82)
  • Aggressive B-cell non-Hodgkin lymphoma (OR vs Hodgkin lymphoma, 0.50; 95% CI, 0.37–0.69)
  • Indolent B-cell non-Hodgkin lymphoma (OR vs Hodgkin lymphoma, 0.58; 95% CI, 0.43–0.77)
  • Anti-CD20 treatment in the previous 3 months (OR, 0.05; 95% CI, 0.04–0.06)
  • Receiving chemotherapy (OR, 0.12; 95% CI, 0.09–0.16)
  • Bruton tyrosine kinase inhibitor treatment (OR, 0.16; 95% CI, 0.12–0.23)
  • Receiving radiotherapy (OR, 0.21; 95% CI, 0.12–0.39)
  • Receiving an autologous stem cell transplant (OR, 0.29; 95% CI, 0.14–0.58)
  • Thalidomide analogue treatment (OR, 0.34; 95% CI, 0.21–0.57).

Patients with lymphoid malignancies were more likely to have a positive antibody response if they had a previous SARS-CoV-2 infection (OR, 1.93; 95% CI, 1.63–2.29), had received 5 vaccine doses rather than 3 (OR, 1.96; 95% CI, 1.42–2.71), or had plasma cell malignancies (OR vs Hodgkin lymphoma, 3.19; 95% CI, 2.20–4.62).

“Approximately 1 in 5 recipients of solid organ transplants, individuals with rare autoimmune rheumatic diseases, and individuals with lymphoid malignancies have no detectable IgG anti-spike antibodies despite 3 or more vaccine doses, but this proportion decreases with sequential booster doses,” the researchers wrote. “Antibody testing using lateral flow immunoassay tests could enable rapid identification of individuals who are most likely to benefit from additional COVID-19 interventions.”

Several researchers disclosed ties to the pharmaceutical industry.

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