COVID-19 Vaccine Booster Dose Beneficial to Immunocompromised Patients

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A recent study found that, of 423 participants who were initially low responders, 90% increased their antibody concentrations to more than 400 AU/mL.

A COVID-19 vaccine booster dose can help immunocompromised patients generate a strong defense against the disease, according to research published in the journal the Lancet Rheumatology.1 The authors said the findings support strategies at the national and international level that promote booster doses.

COVID-19 Vaccine Booster Dose Beneficial to Immunocompromised Patients / PhotobyTawat - stock.adobe.com

COVID-19 vaccines are known to prevent severe illness, hospitalization, and death among the general population. However, studies have shown that immunocompromised patients—particularly organ transplant recipients—have significantly lower seroconversion rates and antibody titers after getting vaccinated.2

Key Takeaways

• Research published in The Lancet Rheumatology suggests that a COVID-19 vaccine booster dose can significantly enhance antibody levels and T-cell responses in immunocompromised patients.
• Results showed that 90% of low responders saw a substantial increase in antibody concentrations after a third vaccine dose, while detectable T-cell responses were observed in 80% of participants.
• While boosters proved effective in enhancing immunity for most participants, over half of non-responders did not develop sufficient antibody defenses even after the third dose.

A team of investigators from the University of Birmingham and the University of Glasgow conducted a study to determine the value of a third vaccination in a wide range of patients with primary and secondary immunodeficiencies. The trial, called OCTAVE-DUO, was an open-label, multi-center, randomized, controlled, phase 3 study conducted in 11 hospitals in the United Kingdom.

READ MORE: Smell Loss Still Impacted Some Patients 1 Year After COVID-19 Diagnosis

"Our first OCTAVE study revealed a group of patients who may not mount a sufficient immune response following a vaccine dose, which is why the OCTAVE-DUO study is so important," Iain McInnes, lead investigator on the study, said in a release.3 "For the clinically vulnerable in our society, [a] vaccine booster program offers important protection, therefore further understanding of the effectiveness of vaccines in people with immune-mediated inflammatory diseases is extremely important."

OCTAVE-DUO included 804 adult participants across 9 disease cohorts, including solid cancer, lymphoid malignancy, immune-mediated rheumatic disease, chronic renal disease, chronic liver disease, and gastrointestinal disease, who had an inadequate response to 2 doses of a COVID-19 vaccine. Patients were randomly assigned between August 2021 and March 2022 to receive 1 of 3 vaccines: Pfizer's BNT162b2, Moderna's mRNA-1273, or Novavax's NVX-CoV2373.

The primary study outcome was "vaccine-specific immunogenicity as defined by the concentrations of anti-SARS-CoV-2 spike antibodies and T-cell responses to SARS-CoV-2 spike peptides 21 days after the third vaccine dose compared with pre-third vaccine responses."

Investigators found that, 21 days after receiving a third vaccine dose, anti-SARS-CoV-2 spike antibodies among participants were significantly higher compared to baseline. Of 423 participants who were initially low responders, 90% increased their antibody concentrations to more than 400 AU/mL. Detectable T-cell responses were also seen in 80% of 616 participants.

Additionally, of 308 participants who were non-responders at baseline, 54% had no response after a third vaccine dose. There were 24 serious adverse events during the trial: 8 in participants who received BNT162b2, 12 in mRNA-1273, and 4 in NVX-CoV2373. However, only 2 were categorized as vaccine-related.

"It is encouraging to see that boosters helped to increase antibody defenses in 9 in 10 participants who hadn't previously mounted a defense after two jabs," Pamela Kearns, lead investigator on the study, said in a release.3 "However, more than half of those who didn't respond at all to an initial course of vaccines didn't develop any antibody defense after boosters. This underscores the need for other protective factors to support the most clinically vulnerable in society and continue to be vigilant against Covid in society."

"It is encouraging to see the results of OCTAVE-DUO, which provides important answers and reinforces the need to support and protect patients who are more clinically vulnerable," added McInnes.

READ MORE: Immunization Resource Center

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References

1. Goodyear CS, Patel A, Barnes E, et al. Immunogenicity of third dose COVID-19 vaccine strategies in patients who are immunocompromised with suboptimal immunity following two doses (OCTAVE-DUO): an open-label, multicenter, randomized, controlled, phase 3 trial. Lancet Rheumatol. Published online May 8, 2024. doi:10.1016/S2665-9913(24)00065-1

2. Lee ARYB, Wong SY, Chai LYA,et al. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis BMJ 2022; 376 :e068632 doi:10.1136/bmj-2021-068632

3. A third Covid vaccine dose improves defense for some clinically extremely vulnerable patients. News Release. University of Glasgow. May 8, 2024. Accessed May 14, 2024. https://www.gla.ac.uk/news/headline_1071135_en.html