Related Experiment Video
Updated: Aug 3, 2025
Protocol for Recombinant RBD-based SARS Vaccines: Protein Preparation, Animal Vaccination and Neutralization Detection
Published on: May 2, 2011
Anti-S1/RBD-Specific Antibody Formation After SARS-CoV-2 Vaccination in Elderly Rheumatoid Arthritis Patients:
Eun Song Kang1,2, Ji Seon Oh3, Eun-Ju Lee4
1Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
The third mRNA vaccine dose significantly boosted antibody titers in rheumatoid arthritis (RA) patients previously vaccinated with ChAdOx1-S. This booster is particularly beneficial for RA patients with risk factors like older age, male sex, and corticosteroid use.
Area of Science:
- Immunology
- Vaccinology
- Rheumatology
Background:
- Rheumatoid arthritis (RA) patients face evolving COVID-19 vaccination guidelines.
- Effectiveness of COVID-19 booster vaccines and antibody generation in RA patients is under continuous discussion.
- Investigating the impact of a third mRNA vaccine dose on antibody titers in RA patients post-ChAdOx1-S vaccination.
Purpose of the Study:
- To evaluate the effect of a third mRNA vaccine dose on antibody titers in rheumatoid arthritis (RA) patients.
- To identify factors associated with antibody production in RA patients after initial ChAdOx1-S vaccination.
- To compare antibody titers between RA patients receiving two ChAdOx1-S doses versus those with an additional mRNA booster.
Main Methods:
- Prospective recruitment of two RA patient groups: one with two ChAdOx1-S doses, the other with an additional mRNA vaccine.
- Quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers using electrochemiluminescence immunoassay.
- Multivariate logistic regression to identify factors influencing antibody production, with follow-up of antibody titers post-third dose.
Main Results:
- A third mRNA vaccine dose significantly increased high antibody titers (>250 U/mL) from 31% to 94% in RA patients.
- Corticosteroid use, older age, and male sex were associated with lower high antibody titers after two ChAdOx1-S doses.
- Minimal antibody titer waning was observed in patients followed up after the third mRNA vaccine dose.
Conclusions:
- The third mRNA vaccine dose demonstrates significant benefit for RA patients, particularly those with risk factors.
- Older age, male sex, and corticosteroid use are identified as risk factors for suboptimal antibody response post-initial vaccination.
- The findings support the recommendation of a third mRNA vaccine dose for enhanced protection in vulnerable RA patient populations.
Background:
The guidelines of coronavirus disease 2019 (COVID-19) vaccination in patients with rheumatoid arthritis (RA) have been continuously updated, with extensive discussion on the effectiveness of the COVID-19 booster vaccines and antibody generation associated with the different types of vaccine. We investigated the effects of the third dose of the mRNA vaccine on antibody titer and the factors associated with antibody production in patients with RA who had previously received two doses of the ChAdOx1-S nCoV-19 vaccine.
Methods:
Between October 14, 2021 and June 17, 2022, two patient groups diagnosed with RA were recruited prospectively: one with two doses of ChAdOx1-S nCoV-19 and the second group with the additional third mRNA vaccine. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers were determined through semiquantitative anti-SARS-CoV-2 spike (S) electrochemiluminescence immunoassay. Antibody titers were compared in both groups considering clinical features and medications. Multivariate logistic regression was performed to identify the factors associated with antibody production. Also, we followed up the antibody titers of whom completed the 3rd mRNA vaccination.
Results:
Among 261 patients, all patients were over 60 years old except for 7 patients and the average age was 65 years; 153 had completed two doses of ChAdOx1-S nCoV-19, while 108 patients had also received the third mRNA vaccine. The positive rates of anti-SARS-CoV-2 anti-S1/receptor binding domain-specific antibody (titer > 0.8 U/mL) were 97% (149/153) and 99% (107/108) respectively. However, positive rates for high antibody titer (> 250 U/mL) were found in only 31% (47/153) of group 1 but 94% (102/108) of group 2. Multivariate analysis revealed that corticosteroid use (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.16-0.75), older age (OR, 0.91; 95% CI, 0.860-0.98), and male sex (OR, 0.23; 95% CI, 0.07-0.74) were associated with a lower rate of high antibody titer acquisition after two doses of ChAdOx1-S nCoV-19. Waning of antibody titers was observed in only two of 46 patients who followed up twice after the third mRNA vaccine inoculation.
Conclusion:
Our findings suggest that the third dose of the mRNA vaccine could be beneficial in RA patients with risk factors including older age, male sex, and corticosteroid use after two doses of ChAdOx1-S nCoV-19.
Related Concept Videos
01:23Rheumatic Heart Disease I: Introduction
00:42Cross-reactivity
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies