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Combo therapy and covid vaccine, anyone had a serology test confirming immunization?

Lady Organic

Moderator
Staff member
Has anyone who takes a biologic (Humira, remicade) + immunosuppressant (Aza (Imuran), 6-mp (purinethol) or methotrexate) has had the covid vaccine and had a serology test afterwards?
 

my little penguin

Moderator
Staff member
No test afterwards -only one shot so far
But Ds had gotten one covid shot
Pzfier due to his age
He is on two biologics (including Stelara) plus methotrexate
Second shot this week
 

Lady Organic

Moderator
Staff member
I fear the immunosupressant (purinethol) will leave me unprotected after 2 shots. Not knowing if seroconvertion occured for people with our situation is not cool. i'd be happy to return to a normal life (covid stress-free), seeing my friends, not wearing the masks, etc, after my 2 shots, but I feel this wont really be possible until I get a confirmation I am protected.
I wish I could find a can a private lab that makes serology testing, but cant find one.
what are your thoughts?
 

my little penguin

Moderator
Staff member
Our plan
Get the shots -wait
Watch the trials and studies
Get the booster when offered
And hope by then there are enough studies on combo
What we know at this point
Stelara and his other biologic do not reduce the formation of antibodies after the vaccine
For ds we don’t know how much methotrexate does
So we were told to hold it for 7 days after the shot
In this case he got mtx last Thursday
Get the shot this Wednesday
So no mtx till next Thursday (basically two weeks -1 week before and 1 week after )

flu has similar outcomes on the flu vaccine and mtx
 
Location
San Diego
I've seen some reports of the effects of combo therapy on the response to other vaccines but not yet to COVID vaccines. For the other vaccines it looked liike it typically cut the antibody response by about 1/3rd. Still a substantial response but less than those not on immunosuppressive therapy.
 
Location
San Diego
Okay, I found this recent paper:


However it is a study of the reduced vaccine response in solid organ transplant recipients, which generally get a much harsher immune suppression than do IBD patients. It reports a significantly reduced antibody response in the trnasplant group receiving antimetabolite drugs including azathioprine (but not anti-TNFs).

From the paper:
"In this study of the humoral response to 2 doses of
mRNA SARS-CoV-2 vaccine among solid organ transplant recipients,
the majority had detectable antibody responses after
the second dose, although participants without a response
after dose 1 had generally low antibody levels. Poor
humoral response was persistently associatedwith use of antimetabolite
immunosuppression.

Although no threshold has been established for protective
immunity, antibody levels were well below that which has
been observed in immunocompetent vaccinees."
 
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Lady Organic

Moderator
Staff member
thank you,
I wish they would give the antimetabolite dosage participants were taking. I have also heard organ transplant patients take higher doses, but how much more? 2, 3 x more? I can only find examples on the web for leukemia and dosages seem to vary depending on stage of disease.
 

Lady Organic

Moderator
Staff member
thank you,
DOSE AND ADMINISTRATION ADULT
Kidney Transplant Recipients: If azathioprine is to be used, a maintenance adult dose of approximately 1.5 mg/kg/day PO is given once daily.

I am not sure how to convert this into purinethol (6-mp)
it seems even less than what I take:(
 

my little penguin

Moderator
Staff member
Azathioprine (AZA) and 6-mercaptopurine (6-MP) are accepted as effective therapy for Crohn's disease and ulcerative colitis. Although general guidelines have been suggested for weight-based dosing of thiopurines, no standard of care has been established. Clinical trials have demonstrated efficacy for weight-based dosing of AZA at 2.5 mg/kg/day and 6-MP at 1.5 mg/kg/day. Escalation of dosing is recommended within 2 weeks of initiating therapy. The aim was to determine the prescribing practices of community practice gastroenterologists with respect to 6-MP/AZA dosing.
from
 
Hello,

I am new here and from the midwestern U.S. . Am on Remicade & Methotrexate and am currently having mini panic attack about not knowing at how much increased risk I am at. Have been trying to follow the studies out there that are honestly depressing and the incredibly vague and unhelpful guidance coming from the CDC and my doctors.

Unfortunately I am in a busy office that is in the process of going back to 100% capacity and re-opening to a steady stream of customers and employees from other departments meeting with my co-workers. I am unable to evaluate my risk to present to HR for accommodations and unfortunately cannot work remote at this time.

Any ideas of when we will hopefully know more and possibly be able to get booster shots if we are indeed proven to not be protected. I have sent an message to my doctor's asking about the possibility of an antibody screening to get a better idea of what I am up against but I've seen reports that these tests are a waste of time and money and don't show anything relevant to how much protection we may or may not have.

Greatly stressed and going out of my mind with worry,

Cheers,
Joe
 

Lady Organic

Moderator
Staff member
Hi Joe and welcome,
I feel your worries. Its unfortunate for us we have to keep going with so much unknown.
Could your GI doctor write a letter for your work? To explain its unsure you are protected because of your immunosuppressive status and that because of this you would benefit special accommodations, until a test or a booster is given to you?
I wear 2 masks when I go in public, if this could help in the meantime.
 
Location
San Diego
I have sent an message to my doctor's asking about the possibility of an antibody screening to get a better idea of what I am up against but I've seen reports that these tests are a waste of time and money and don't show anything relevant to how much protection we may or may not have.
COVID antibody tests are wasteful for testing anybody and everybody who recieved the vaccine, because a large majority of them will respond very nicely, and you don't need a test to tell you that. But for us who are immunosuppressed the question looms rather larger. That's why I would go ahead and get the antibody test if I were you - to confirm that you have made measurable antibodies against the key viral spike protein. That won't absolutely prove that you are protected, but it would be strong evidence suggesting that you very likely are.

Commercial labs such as Labcorp and others offer antibody tests to the general public. I'm not sure, but I believe that you don't necessarily need a doctor's prescription, although it is probably better for insurance purposes if you do.
 

my little penguin

Moderator
Staff member
Labcorp charges a $10 service fee to have one of their docs write the “script” for the test
Need to verify if quest or other labs are the same
 

Lady Organic

Moderator
Staff member
Antibody test not available yet where I live.
Important to get the right test, (SPIKE antibody Test):


''What is the intended use of the SARS-CoV-2 Nucleocapsid Total Antibody Test (ACOV)?
The COVID-19 (SARS-CoV-2) Nucleocapsid Total Antibody Test (ACOV) is intended to determine the antibody status for individuals previously diagnosed with COVID-19, and can also help identify individuals who have been naturally exposed to the virus. This test is to be used for natural exposure only, and not to be used for post-vaccine antibody testing.

What is the intended use of the SARS-CoV-2 Spike Antibody Test (QCOV)?
The SARS-CoV-2 Spike Total Antibody Test (QCOV) checks for the presence of spike protein antibodies following past natural exposure or following vaccination against COVID-19.

Antibody testing should NOT be used to infer immunity status''
 
Has anyone who takes a biologic (Humira, remicade) + immunosuppressant (Aza (Imuran), 6-mp (purinethol) or methotrexate) has had the covid vaccine and had a serology test afterwards?
yes. I am on humira/adalimumab. I just heard back on my serology test (post Pfizer vaccine). Negative - so no antibodies. Not good news
 

Lady Organic

Moderator
Staff member
I just read you had 2 doses of the vaccine. wow, I am sorry to hear that. This shows the importance for us of testing and if tested negative, wait for a third dose.
Its too bad the medical authorities do not take the lead on this matter and at least inform us. I am sure a lot of immunosuppressed people will get sick thinking they were protected. Nobody in Canada talks about this issue on the news. We only get the message to get vaccinated over and over and thats it, no further instructions for minority groups.
 
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I just read you had 2 doses of the vaccine. wow, I am sorry to hear that. This shows the importance for us of testing and if tested negative, wait for a third dose.
Its too bad the medical authorities do not take the lead on this matter and at least inform us. I am sure a lot of immunosuppressed people will get sick thinking they were protected. Nobody in Canada talks about this issue on the news. We only get the message to get vaccinated over and over and thats it, no further instructions for minority groups.
agreed. They are so worried about reducing uptake of the vaccine we dont get full information. I was warned by my specialist the data wasnt looking promising but am still reeling as was just starting to get out there and enjoy the relaxations starting to happen here. Now i want to find out if there is any way of getting a shot of another vaccine on another platform.
 
My primary care provider just refused to to order a spike protein antibody test and said to get one of the over the counter ones at CVS. Looks like I am going to have to go to my GI to get it hopefully ordered and then find a new PCP.
 

Lisa

Adminstrator
Staff member
Location
New York, USA
My primary care provider just refused to to order a spike protein antibody test and said to get one of the over the counter ones at CVS. Looks like I am going to have to go to my GI to get it hopefully ordered and then find a new PCP.
Any reasoning behind why they would not order it?
 
I am reading between the lines but when I saw the PCP last and expressed my concerns to her about vaccine effectiveness while taking certain medications she was immediately dismissive and said something about the vaccine being safe and effective. Anyways I don't trust her anymore. She is either underinformed or is intentionally tying to give me the brush off.
 
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