A serologic response has been reported in patients with generalized pustular psoriasis (GPP) receiving treatment with biologic agents or methotrexate (MTX) following a 2-dose mRNA COVID-19 vaccination, according to findings from a noninterventional, prospective cohort study conducted in Turkey and published in the journal Vaccine.

Recognizing that data on immune responses to COVID-19 vaccines in patients with GPP are sparse, the researchers sought to assess SARS-CoV-2 antibody levels following Pfizer/BioNTech or CoronaVac mRNA vaccination in individuals receiving MTX or a biologic therapy. The impact of biologic agents on vaccine efficacy, immunogenicity, and adverse effects were examined as well.

Current recommendations regarding COVID-19 vaccination in patients with psoriasis are based largely on data from analyses that involved autoimmune inflammatory rheumatic disorders, which differ from psoriasis in comorbidities, treatments, and disease characteristics.

The current study was conducted between February 2021 and September 2021. Individuals with psoriasis who were 18 years of age or older and were using MTX or a biologic agent, antitumor necrosis factor-alpha, anti-interleukin 17 (anti-IL17), anti-IL12/23, or anti-IL-36r, as well as controls, who had received 2 COVID-19 vaccine doses were selected for the analysis.

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The primary study outcomes included neutralizing and anti–SARS-CoV-2 spike protein antibody levels following 2 doses of an mRNA vaccine in MTX- or biologic-treated patients with psoriasis, including GPP.

Eighty-nine patients with psoriasis and 40 controls were enrolled in the study and received 2 doses of inactivated (CoronaVac) or Pfizer/BioNTech mRNA vaccine. The median patient age was 46 years in those with psoriasis and
47 years in controls. In all participants, antispike and neutralizing antibodies were evaluated prior to and at 3 to
6 weeks following the second vaccine dose.

Results of the study showed that median anti-SARS-CoV-2 spike antibody titers following CoronaVac vaccination were lower among patients compared with controls (57.92 U/mL [range, 8.6-152.8 U/mL] vs 125.4 U/mL [range, 54.6-347.5 U/mL], respectively). Individuals with psoriasis developed significantly lower antibody levels than the controls
(P =.012).

Regarding neutralizing antibody titers, which were evaluated in 37 patients and 21 controls, median titers were (16.7%; 1 of 6 participants) and (3.1%; 1 of 32 participants) among those with psoriasis vs controls, respectively, thus demonstrating statistically significantly lower neutralizing antibody titers in patients than controls (P =.005).

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Further, a significantly lower percentage of patients (29.7%; 11 of 37 participants) than controls (66.7%; 14 of 21 participants) had neutralizing antibody titers above 1/20 (P =.006). All of the participants developed seropositivity.

Psoriasis flare was observed in 6.74% (6 of 89) of the participants, among whom 5 had been diagnosed with GPP. The disease flare was reported 2 to 4 weeks after vaccination with either dose. Additionally, flare was seen in another individual with GPP 7 days following the second dose of the Pfizer/BioNTech mRNA vaccine, with a GPP severity score of 10, indicative of moderate severity, reported in this patient.

“All patients with psoriasis should be vaccinated without withholding their biologic treatment,” the researchers noted. “Vaccination against COVID-19 should be encouraged as part of routine clinical care, and further studies . . . to investigate the longevity of vaccine-elicited immunity should be carried out,” they concluded.


Ergun T, Hosgoren Tekin S, Apti Sengun O, et al. Immunogenicity, efficacy, and safety of CoronaVac and Pfizer/BioNTech mRNA vaccines in patients with psoriasis receiving systemic therapies: a prospective cohort study. Vaccine. Published online June 3, 2023. doi:10/1016/j.vaccine.2023.05.052