Comparison of the immunogenicity and safety among COVID-19 vaccines ChadOx-1, CoronaVac and BNT162b2 in systemic lupus erythematosus (SLE) patients: a prospective cohort

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Abstract Background The immune response and safety using different COVID-19 vaccine platforms in patients with immune mediated rheumatic diseases is still uncertain. The objective of this study is to compare the immunogenicity and safety after two doses of BNT162b2, CoronaVac and ChadOx-1 in SLE patients. Methods Prospective study including SLE patients who received a primary schedule to COVID-19 vaccination between May and August 2021. Immunogenicity, events supposedly attributable to vaccination or immunization (ESAVI) and disease activity were assessed at baseline and after each vaccine dose. Results 121 SLE patients were included in the cohort, 88 in the immunogenicity analysis and 118 in the safety analysis. The groups were homogenous concerning sex, age, and comorbidities. Seropositivity after two doses of vaccines was similar between CoronaVac (68%), ChadOx1 (80,6%) and BNT162b2 (88%) (p=0.231). However, CoronaVac and ChadOx-1 presented lower titers in comparison with BNT162b2. Regarding ESAVI, the most frequent reported following first and second vaccine doses were, respectively: injection site pain (65.2%/41.1%), headache (50.9%/29.9%) and arthralgia (37.5%/22.5%). Fever and myalgia were more related to ChAdOx1 than CoronaVac (23.3 vs. 5.0%; p=0.025). There was no difference in MEX-SLEDAI between vaccine platforms. No serious ESAVI were reported. Conclusion After two doses, the three COVID-19 vaccine platforms induced a significant increase in antibody titers against SARS-CoV-2. Patients who received BNT162b2 exhibited a higher serological response compared to the other vaccines. All three vaccine platforms demonstrated a favorable safety profile, with no serious ESAVI or worsening of disease activity. Clinical trial Number The study was registered in The Brazilian Registry of Clinical Trials (ReBEC) in 04/14/2021 with code RBR-108fyykd.

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