The Impact of Immune-Modifying Treatments for Skin Diseases on the Immune Response to COVID-19 Vaccines: a Narrative Review

TY - JOUR

T1 - The Impact of Immune-Modifying Treatments for Skin Diseases on the Immune Response to COVID-19 Vaccines

T2 - a Narrative Review

AU - Liew, Su Yi

AU - Tree, Timothy

AU - Smith, Catherine H.

AU - Mahil, Satveer K.

N1 - Funding Information: Dr Mahil is supported by a National Institute for Health and Care Research (NIHR) Advanced Fellowship (NIHR302258). Funding Information: Su-Yi Liew declares that she has no conflict of interest. Catherine Smith reports grants from Abbvie, grants from Sanofi, grants from Novartis, and grants from Pfizer, outside the submitted work. Satveer Mahil reports departmental income from Abbvie, Almirall, Eli Lilly, Novartis, Sanofi, UCB, outside the submitted work. Timothy Tree reports grants from GlaxoSmithKline, Sanofi and Imcyse SA, and consultancy fees from GlaxoSmithKline, Novartis, UCB and Quell Therapeutics, outside the submitted work. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12

Y1 - 2022/12

N2 - Purpose of Review: SARS-CoV-2 has had a devastating global effect, with vaccinations being paramount in the public health strategy against COVID-19. Vaccinations have uncoupled infection from adverse COVID-19 outcomes worldwide. While immune-modifying therapies are effective for the management of skin diseases such as psoriasis and atopic dermatitis, these medications also impair protective immune responses. There has been longstanding uncertainty and concern over the impact of immune-modifying therapies on the effectiveness of vaccines; for example, it is well recognised that methotrexate impairs humoral responses to both influenza and pneumococcal vaccines. This narrative review aims to discuss the evidence to date on the impact of immune-modifying therapies on the immune response to COVID-19 vaccines, with a focus on the first two vaccine doses. Recent Findings: Individuals receiving immune-modifying therapy are more likely to have attenuated humoral responses to a single dose of COVID-19 vaccine compared to healthy controls; however, this may be improved by a complete course of vaccination. B cell targeted biologics such as rituximab markedly impair the humoral response to both the first and second COVID-19 vaccination. There remains a paucity of data on cellular immune responses, with the few available studies indicating lower responses to two vaccine doses in individuals receiving immune-modifying therapies compared to healthy controls, which may impact the durability of immune responses. Summary: Inadequate humoral immune responses to a single dose of vaccine in the context of immune-modifying therapy are improved by a complete course of vaccination. Individuals receiving immune-modifying treatments should be encouraged to take up a complete vaccine course to mitigate their risk against COVID-19. Research in large patient populations on the longevity/kinetics of the complex humoral and cellular response to subsequent vaccine doses, including against newer variants of concern, is warranted, in addition to data on immune correlates of vaccine clinical effectiveness.

AB - Purpose of Review: SARS-CoV-2 has had a devastating global effect, with vaccinations being paramount in the public health strategy against COVID-19. Vaccinations have uncoupled infection from adverse COVID-19 outcomes worldwide. While immune-modifying therapies are effective for the management of skin diseases such as psoriasis and atopic dermatitis, these medications also impair protective immune responses. There has been longstanding uncertainty and concern over the impact of immune-modifying therapies on the effectiveness of vaccines; for example, it is well recognised that methotrexate impairs humoral responses to both influenza and pneumococcal vaccines. This narrative review aims to discuss the evidence to date on the impact of immune-modifying therapies on the immune response to COVID-19 vaccines, with a focus on the first two vaccine doses. Recent Findings: Individuals receiving immune-modifying therapy are more likely to have attenuated humoral responses to a single dose of COVID-19 vaccine compared to healthy controls; however, this may be improved by a complete course of vaccination. B cell targeted biologics such as rituximab markedly impair the humoral response to both the first and second COVID-19 vaccination. There remains a paucity of data on cellular immune responses, with the few available studies indicating lower responses to two vaccine doses in individuals receiving immune-modifying therapies compared to healthy controls, which may impact the durability of immune responses. Summary: Inadequate humoral immune responses to a single dose of vaccine in the context of immune-modifying therapy are improved by a complete course of vaccination. Individuals receiving immune-modifying treatments should be encouraged to take up a complete vaccine course to mitigate their risk against COVID-19. Research in large patient populations on the longevity/kinetics of the complex humoral and cellular response to subsequent vaccine doses, including against newer variants of concern, is warranted, in addition to data on immune correlates of vaccine clinical effectiveness.

KW - COVID-19 vaccine

KW - Immune-modifying therapy

KW - Immunosuppression

KW - Skin disease

UR - http://www.scopus.com/inward/record.url?scp=85141032930&partnerID=8YFLogxK

U2 - 10.1007/s13671-022-00376-3

DO - 10.1007/s13671-022-00376-3

M3 - Review article

AN - SCOPUS:85141032930

SN - 2162-4933

VL - 11

SP - 263

EP - 288

JO - Current Dermatology Reports

JF - Current Dermatology Reports

IS - 4

ER -