Paul R. Fortin, MD, MPH, FRCPC: COVID-19 Vaccine for Patients With Rheumatic Disease

Rheumatology Network interviewed Paul R. Fortin, MD, MPH, FRCPC, to discuss his ACR presentation, “COVID-19 Vaccine in Immunosuppressed Adults with Autoimmune Diseases.” Fortin is Professor of Medicine at CHU de Quebec Universite Laval in Quebec, Canada.

Below is a preview of our conversation:

Rheumatology Network: What sparked your team's interest in examining the vaccine in those who are immunosuppressed and immunocompromised?

Paul R. Fortin, MD, MPH, FRCPC: Well, that started when patients started reaching out to us when there was an announcement that there would be availability for COVID-19 vaccines in our province. The studies that have been done before we started our own project had excluded patients with systemic autoimmune rheumatic diseases, like rheumatoid arthritis or lupus, and patients were concerned that they didn't have any data they could rely on to see whether it was safe and efficacious for them. So, with that in mind, we approached our Ministry of Health and [asked] whether they would be willing to provide us with the vaccines and to allow us to study the response and the possible safety aspect of getting the vaccine in these patients.

RN: Why do you believe B cell treatments cause reduction in immune response rates?

PF: This is the catch 22 of immunosuppression, especially when we target the immune system. The immune problem in lupus and in rheumatoid arthritis is often related to the production of these auto antibodies, and we're targeting those producing cells, those B cells. So, by treating our autoimmune disease, we're unfortunately triggering the expected side effects that the vaccine is not going to be able to stimulate a good response. And that differs from other biologic agents where the target is not specifically the B cells. It's quite logical, when you think about the mechanism of action of these drugs, that you would have a different response. And there are several questions that could be asked now, such as the timing of the vaccination compared to timing of the treatments, especially with the cell-depleting antibodies that are given every 6 months. Maybe there could be optimization; we could not standardize the timing in our study at this point, because of the urgency of vaccinating our patients in the context of big waves in our province. The other question that we'll be asking is if you do reach a good level of antibodies, will that be sustaining at 6 months and 12 months? In fact, we're already getting a third dose as per recommendations of the public health agency here in our province and we're measuring the effect of that third dose, so we had to modify our initial protocols for that [as well].

RN: Is there anything else you would like our audience to know before we wrap up?

PF: One of the messages is that the question was patient-initiated. So that's very relevant. And I think it's a good place to say that advocacy can bring results in terms of modifying the public exposure and the public interest in these questions. The second thing is that both McGill University and our university here in Quebec City, Laval University, had ongoing cohorts of patients with rheumatoid arthritis and lupus that had already been followed for many years. So, it allowed us to really turn around very quickly and start a study within 2 months of asking the question when, traditionally, you would wait 2 years before you could start such a big study.