Immunogenicity and safety of SARS-CoV-2 mRNA vaccine in patients with nephrotic syndrome receiving immunosuppressive agents,Pediatric Nephrology

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Immunogenicity and safety of SARS-CoV-2 mRNA vaccine in patients with nephrotic syndrome receiving immunosuppressive agents
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2022-08-01 , DOI: 10.1007/s00467-022-05633-y
Koichi Kamei ₁ , Masao Ogura ₁ , Mai Sato ₁ , Kentaro Nishi ₁ , Kensuke Shoji ₂ , Takanori Funaki ₂ , Chikara Ogimi ₂ , Shuichi Ito ₃

Affiliation

Background

As there are no large-scale reports of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mRNA vaccination in patients with nephrotic syndrome using immunosuppressive agents, we conducted the prospective study.

Methods

SARS-CoV-2 mRNA vaccines were administered to patients with nephrotic syndrome receiving immunosuppressive agents. The titers of SARS-CoV-2 spike protein receptor–binding domain antibodies were measured before and after vaccination. We evaluated factors associated with antibody titers after vaccination and analyzed adverse events.

Results

We enrolled 40 patients and evaluated vaccine immunogenicity in 35 of them. Seroconversion (> 0.8 U/mL) was achieved in all patients, and the median antibody titer was 598 U/mL (interquartile range, 89–1380 U/mL). Patients using mycophenolate mofetil (MMF) showed lower antibody titers than those who were not (median: 272 U/mL vs. 2660 U/mL, p = 0.0002), and serum immunoglobulin G (IgG) levels showed a weak linear relationship with antibody titers (R² = 0.16). No breakthrough infections were noted. Three patients (7.5%) suffered from a relapse of nephrotic syndrome (2 and 3 days, respectively, after the first dose and 8 days after the second dose), two of whom had a history of relapse within 6 months before the vaccination.

Conclusions

The SARS-CoV-2 mRNA vaccine was immunogenic in patients with nephrotic syndrome using immunosuppressive agents, although the use of MMF and low levels of serum IgG were associated with lower antibody titers after vaccination. Patients with high disease activity may experience a relapse of nephrotic syndrome after vaccination.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

SARS-CoV-2 mRNA 疫苗在接受免疫抑制剂治疗的肾病综合征患者中的免疫原性和安全性

背景

由于没有大规模报告使用免疫抑制剂对肾病综合征患者进行严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) mRNA 疫苗接种，因此我们进行了前瞻性研究。

方法

对接受免疫抑制剂治疗的肾病综合征患者接种了 SARS-CoV-2 mRNA 疫苗。在接种疫苗前后测量了 SARS-CoV-2 刺突蛋白受体结合域抗体的滴度。我们评估了与疫苗接种后抗体滴度相关的因素并分析了不良事件。

结果

我们招募了 40 名患者并评估了其中 35 名的疫苗免疫原性。所有患者均实现了血清转化（> 0.8 U/mL），中位抗体滴度为 598 U/mL（四分位间距，89-1380 U/mL）。使用霉酚酸酯 (MMF) 的患者抗体滴度低于未使用霉酚酸酯的患者（中位数：272 U/mL 与 2660 U/mL，p = 0.0002），血清免疫球蛋白 G (IgG) 水平与抗体呈弱线性关系滴度（R ² = 0.16）。没有发现突破性感染。3 名患者 (7.5%) 出现肾病综合征复发（分别在第一次给药后 2 天和 3 天，第二次给药后 8 天），其中两人在接种前 6 个月内有复发史。