Potential protective advantage of the protein-subunit SARS-CoV-2 vaccines, MVC-CoV1901 and NVX-CoV2373, in patients with rituximab-treated immune-mediated inflammatory diseases: Real-world evidence

Since the COVID-19 pandemic, patients with immune-mediated inflammatory diseases (IMID) are recommended to receive SARS-CoV-2 vaccinations to reduce complications following COVID-19 infection. We conducted a case-control study and case analysis to investigate how SARS-CoV-2 vaccine platforms impact COVID-19 outcomes in patients with IMID on chronic rituximab therapies. Our findings suggest that exposure to protein-subunit vaccines were associated with the lowest mortality rates. Specifically, in the multivariate analysis of patients hospitalized for COVID-19, protein-subunit vaccines provided protection against all-cause mortality, particularly in those with lower pre-COVID-19 albumin levels, a surrogate for higher pre-COVID-19 inflammation. These results highlight the potential protective advantages of the protein-subunit vaccines, MVC-CoV1901 and NVX-CoV2373 vaccine, in patients with IMID. Moreover, our data supports heterologous vaccine regimens incorporating protein-subunit vaccines as a viable strategy for patients with IMID. Given the small sample size, further studies are needed to validate the clinical implications of this study.