According to data collected during the Omicron BA.1 wave in New York City (NYC) and published in The Lancet Rheumatology, patients with SLE achieved an enhanced serological response following a COVID-19 vaccine booster dose.

Led by researchers at New York University (NYU) Grossman School of Medicine, the new study tracked the health of 163 fully vaccinated men and women being treated for SLE at its affiliated hospitals in NYC. In the study, researchers sought to assess clinical efficacy and seroreactivity of vaccination against SARS-CoV-2 in previously reported patients from the NYU Lupus Cohort who had received an initial vaccination series with or without an additional vaccination dose, with particular attention to events occurring during the surge of the Omicron BA.1 variant in NYC. All had received some combination of the vaccines manufactured by Pfizer–BioNTech, Moderna, or Johnson & Johnson before June 2021, but only 125 had received a third (or booster) dose of the vaccine.

Among those with breakthrough infections, 28 of 125 (22%) had received a booster, while 16 of 38 (42%) had not. According to investigators, most breakthrough infections (42 of 44) occurred after December 2, 2021, when the city detected its first case of the highly contagious Omicron variant.

Another key study finding was among 57 of the study participants who agreed to have their blood antibody levels checked—once after full vaccination and again after receiving their booster. The researchers discovered that even those on immunosuppression who had not responded to the initial round of vaccination had an immediate rise in antibody levels after the administration of a booster shot. Previous research had demonstrated that these antibody levels were lower among many initially vaccinated patients with rheumatic diseases, including SLE, who were taking immune-suppressing drugs, sparking fears of waning immunity to COVID-19 over time. In these patients, the median antibody titer after a mean of 30.2 days was 397 u/mL and 1,036 u/mL after a mean of 44.7 days. According to the researchers, there was no association between antibody titers after the booster dose and breakthrough infections.

The authors wrote, “To our knowledge, this study represents the first report of the clinical efficacy of the initial vaccination series and an additional dose against COVID-19, inclusive of the Omicron BA.1 wave in New York City, and the first known longitudinal documentation of antibody responses to vaccination against COVID-19 in a cohort of patients with SLE. Protection from infection in patients receiving an additional vaccine dose and the low hospitalization rate of vaccinated patients is reassuring, given the inherent risks in this patient population.”

In a statement, Amit Saxena, MD, MS, study colead investigator, rheumatologist, and assistant professor in the Department of Medicine at NYU Langone Health, stated, “Our study results offer people living with systemic lupus erythematosus clinical confirmation that vaccines are highly effective at guarding against severe COVID-19, despite their increased risk of catching the disease. COVID-19 vaccine boosters, or third shots, offered an added, doubled layer of protection from breakthrough infection. Even in cases of SARS-CoV-2 infection, cases were overwhelmingly mild among patients with SLE who were fully vaccinated.”

Study cosenior investigator, rheumatologist, and associate professor in the Department of Medicine at NYU Langone, Peter M. Izmirly, MD, stated, “Our research also shows that most people with systemic lupus erythematosus who are fully vaccinated and boosted mounted good responses despite being on immune suppression.”

Lastly, the researchers cautioned that further monitoring of patients is necessary to ascertain if there is any antibody “cutoff” level below which patients with SLE become more vulnerable to SARS-CoV-2 infection.

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