Thread by @aishaikh

“Antibody response to Moderna (mRNA-1273) vaccine in hemodialysis patients with and without prior COVID-19”- our manuscript published in @CJASN

@LilCh4n, @Nick84130497 @ZeldisEtti @kirkcampbell @NephJC

👉🏽 cjasn.asnjournals.org/content/early/…

Study findings 🧵
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⚡️Antibody (Ab) response to Pfizer vaccine in hemodialysis pts. has been reported, but the Ab response to Moderna vaccine in hemodialysis patients is not well known
Here we report Ab response to Moderna vaccine in patients on maintenance hemodialysis
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⚡️61 hemodialysis patients received the 2-dose Moderna vaccine series
-Of the 61 hemodialysis patients, 20 patients had prior h/o COVID-19
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⚡️m-RNA vaccines cause antibody formation against the Spike protein of SARS-CoV-2 virus
⚡️Receptor Binding Domain (RBD) is located in the Spike-1 protein
⚡️We measured anti-RBD IgG antibody titer to assess the humoral response to the Moderna vaccine👇🏽
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⚡️Pre-vaccine Anti-RBD IgG titer was checked in all hemodialysis patients

⚡️Not surprisingly the pre-vaccine anti-RBD IgG titer was positive in the group of hemodialysis patients with prior COVID-19 but negative in the group without prior COVID-19
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⚡️Following the 1st Moderna vaccine dose administration, anti-RBD IgG antibody titer was checked at 1-week, 2-week, 4-week
⚡️2nd Moderna vaccine dose was administered at 4-week and anti-RBD IgG titer was checked again one week after the 2nd vaccine dose👇🏽
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⚡️In hemodialysis patients with prior COVID-19, the anti-RBD IgG titer increased 1-week after the
‘1st vaccine dose’

⚡️In hemodialysis patients without prior COVID-19, the anti-RBD IgG titer increased 1-week after the ‘2nd vaccine dose’👇🏽
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⚡️95% (58/61) hemodialysis patients in our cohort mounted an anti-RBD IgG response by 1-week after the 2nd Moderna vaccine dose
⚡️5% (3/61) patients did not mount an anti-RBD IgG response, and one of the non-responder was on Rituximab & steroids
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⚡️The median age of our cohort was 70-years. 95% patients were male and 85% were black 👇🏽
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⚡️The findings of the study are reassuring as it demonstrates that majority of the hemodialysis pts. mount an antibody response to the Moderna vaccine
⚡️However, the duration of protection and protection against the SARS-CoV-2 variants remains to be seen
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⚡️In this study we report the anti-RBD IgG titer

⚡️But a ‘positive’ antibody titer may not always be equal to ‘neutralizing’ antibody titer

⚡️Key question is: how well do these vaccines protect the hemodialysis patients from COVID-19
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⚡️In this cohort, no new cases of COVID-19 were diagnosed in hemodialysis patients up to 34-days following the 2nd Moderna vaccine dose administration
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‼️However, after this manuscript submission, one patient tested positive for SARS-CoV-2 RNA on RT-PCR on surveillance testing, >40 days after the 2nd vaccine dose
Pt. was asymptomatic & had detectable anti-RBD IgG
(unpublished data)
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⚡️Viral genetic sequencing revealed that this pt. had the B.1.526 variant (also known as the New York variant) which has been categorized as a ‘variant of interest’ by CDC & it may have reduced neutralization by antibodies generated from vaccines👇🏽
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⚡️This pt. remained asymptomatic during the course of SARS-CoV-2 RT-PCR positivity

⚡️It is likely that the Moderna vaccine & the resultant immune response was protective against symptomatic & severe disease due to this variant
(unpublished data)
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⚡️Several answered questions:

-HD patients who fail to mount an Ab response, should they get the 3rd vaccine shot?

-Is one dose of Moderna vaccine sufficient for protection in HD patients with prior COVID-19?

-Vaccine efficacy against variants?
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Summary:
95% Hemodialysis pts. developed anti-RBD IgG in response to the Moderna vaccine

-In pts. with prior COVID-19 antibody titer ⬆️ 1-wk after 1st vaccine dose

-In pts. without prior COVID-19 antibody titer ⬆️ 1-wk after 2nd vaccine dose

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