Reduced SARS-CoV-2 Vaccine Response in Patients Treated with Biologic Therapies for Asthma and Atopic Dermatitis

SARS-CoV-2 vaccines confer great protection against COVID-19 in healthy adults, but it is unknown how patients with severe asthma and atopic dermatitis on biologic therapies respond despite animal data suggesting a lower response. We conducted a prospective observational trial from February to September 2021 and recruited adults with severe asthma or atopic dermatitis treated with benralizumab, mepolizumab or dupilumab, receiving SARS-CoV-2 mRNA vaccination. Patients with prior COVID-19 or significant immunosuppression were excluded. Blood samples were taken from 74 patients and 39 healthy controls and analyzed for SARS-CoV-2 antigen reactivities using a multiplex Luminex assay. Patients treated with biologic therapies had lower IgG levels to the SARS-CoV-2 receptor-binding domain compared to healthy adults 30 days after the second vaccination. Ninety days after the second vaccination, IgG levels for patients on biologic therapies remained significantly lower compared to healthy adults (average median fluorescence intensity 66,437 and 100,519, respectively; p-value 0.0276). Similar results were seen for Delta variant and Spike protein S1 titers. Our data suggest that patients with severe asthma or atopic dermatitis on biologic therapies have lower antibody levels after SARS-CoV-2 mRNA vaccination compared to healthy adults. It is unclear if these differences are due to the biologic therapies or confounding factors commonly seen in these patients. Nevertheless, as there is evidence that lower vaccine-specific titers afford less protection against COVID-19, clinicians should consider a booster vaccination in these patients as they may unknowingly remain at high risk for severe disease.