In a study of patients with the rare multisystem disease lymphangioleiomyomatosis (LAM), responses to COVID-19 mRNA vaccines were similar with and without sirolimus treatment, letter authors write. “Those patients taking sirolimus who have low or no serological response after 2 doses of mRNA vaccines may respond to a 3rd vaccination,” the authors conclude.
The study included 35 women with a confirmed diagnosis of LAM based on the American Thoracic Society/Japanese Respiratory Society Clinical Practice Guidelines, 2 of whom were positive for anti-nucleocapsid SARS-CoV2 antibodies. “Of the 23 patients treated with sirolimus, 11 received the Moderna vaccine and 12 received the Pfizer-BioNTech vaccine. Of the patients not taking sirolimus, 5 received the Moderna vaccine and 7 received the Pfizer-BioNTech vaccine. Serology data were collected 103 ± 78 days and 121 ± 98 days after the second vaccination for patients on sirolimus and not on sirolimus, respectively. A widespread serological response was observed. The median anti-spike antibody level was 1,823 [IQR 1,033-6,294] U/ml in patients with LAM on sirolimus and was comparable to the level of 2,456 [IQR 910.9-13,271.3] U/ml in patients with LAM not on sirolimus (P = 0.54). There were two patients with LAM who did not have detectable antibody titers following vaccination. Both patients were on sirolimus and received the Pfizer-BioNTech vaccine. Five subjects in our cohort had also received an additional dose of the vaccination. There was an increase in antibody response following the third dose in all 5 patients; however, the response was less pronounced in two subjects.”