Vacinação primária e de reforço contra Covid-19 na doença de Sjögren
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Data
2025-08-01
Autores
Lirio, Maressa Barbosa Beloni
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Universidade Federal do Espírito Santo
Resumo
Introduction: Sjögren’s Syndrome (SSj) is a systemic autoimmune disease characterized by glandular and extraglandular involvement. Patients with SSj, particularly those on immunosuppressive therapy, may exhibit a reduced immune response to vaccination. The COVID-19 pandemic has posed challenges to protecting this population, highlighting the importance of effective and safe vaccination strategies. Objective: To evaluate the immunogenicity and safety of COVID-19 vaccines in patients with SSj, in a prospective cohort. Methods: This observational, longitudinal, prospective study was part of the SAFER cohort and included 51 patients with primary SSj, classified according to the 2016 ACR/EULAR criteria. Immunogenicity was assessed by anti-Spike IgG (IgG-S) levels, expressed as geometric mean titers (GMT) and fold increase in GMT (FI-GMT). Disease activity was measured by the ESSDAI score. Adverse events and COVID-19 infections were also monitored. Evaluations were conducted at four timepoints: before the first dose (T1), before the second dose (T2), before the third dose (T3), and four weeks after the booster (T4). Participants received primary vaccination with AstraZeneca (AZT) or CoronaVac (VAC), and either a homologous booster (AZT) or heterologous booster (BNT162b2 - BNT). Results: The cohort included 51 participants, with a mean age of 46 years; 90% (n = 46) were women. Comorbidities were present in 41% (n = 21), and 27% (n = 14) had high-level immunosuppression. Medications used included immunosuppressive drugs (18%, n = 9), corticosteroids (5.9%, n = 5), DMARDs (20%, n = 10), and hydroxychloroquine (65%, n = 33); 16% (n = 8) were not taking any medication. At baseline, 11% (n = 4/35) had moderate/high disease activity, decreasing to 6.5% (n = 2/35) at T4. Regarding the primary vaccine scheme, 94% (n = 48) received AZT and 5.9% (n = 3) received VAC. Heterologous schemes were used in 73% (n = 37), and homologous in 27% (n = 14), with BNT used as the booster in heterologous schedules. Post-booster COVID-19 infection occurred in 20% (n = 10). Nearly all participants achieved seroconversion (~100%), except those using biologics, who had rates below 80%. IgG-S titers showed progressive increases across timepoints. Both primary vaccines elicited similar humoral responses. However, BNT boosters led to significantly higher GMTs (2148.03) compared to AZT (324.29) (p < 0.001); the immune response fold increase was 6 times higher with BNT (5.98 [2.97 – 12.03], p = 0.001). Seroconversion frequency was 83% for homologous and 100% for heterologous regimens. Adverse events were mild and without statistical significance. In multivariate analysis, BNT booster remained an independent predictor of higher antibody titers. Conclusion: COVID-19 vaccination was safe and effective in patients with SSj, with high antibody titers and seropositivity rates. Heterologous vaccination showed superior immunogenicity compared to homologous regimens, without triggering disease activity
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Doença de Sjögren , Vacinação , Imunogenicidade , Vacinas contra COVID-19 , COVID-19 , Sjögren’s Syndrome , Vaccination , Immunogenicity , COVID-19 Vaccines