Patients with idiopathic pulmonary fibrosis (IPF) do not mount an appreciable antispike antibody response to COVID-19 vaccines, a new study published in ERJ Open Research found. This is the case regardless of antifibrotic treatment in these patients.

“This report is of interest given that impaired immune response following vaccination in most diseases has not been attributed to the disease per se but to the compounds used to treat the disease,” the authors wrote. They said that antifibrotics do not cause further immunosuppression.

During the first wave of the COVID-19 pandemic, patients with fibrotic interstitial lung diseases including IPF who were not vaccinated against SARS-CoV-2 had a higher risk of death from COVID-19. The aim of the present study was to determine humoral responses to 2 doses of the COVID-19 vaccine in patients with IPF and the general population.

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The researchers conducted a multicentre, prospective study between July and October 2021 in 42 patients with IPF, 32 of whom were treated with antifibrotics and 25 controls. Three months after the second dose of the vaccine, the researchers analyzed the levels of anti-SARS-CoV-2 antibodies in the participants’ blood.

They found that the median level of anti-SARS-CoV-2 antibodies was 666.1 AU/mL in patients with IPF receiving antifibrotics and 579.5 AU/mL in patients with IPF not receiving the treatment. In the general population, the levels were much higher with a median of 2118.6 AU/mL.

The suggested threshold of anti-SARS-CoV-2 antibodies is 1000 AU/mL. Only 21.% of those treated with antifibrotics had antibody levels above this threshold. Similarly, less than half (40%) of patients with IPF who did not receive antifibrotics had antibodies above the threshold while the prevalence of antibodies above the threshold was 72% among the general public.

The researchers concluded that low levels of protective antibodies, as well as fibrotic lung diseases, are independent factors for increased risk of death following COVID-19. “Our findings are important and should prompt national authorities to prioritize those subgroups of patients for booster doses and stringent precautions,” they wrote.


Karampitsakos T, Papaioannou O, Dimeas I, et al. Reduced immunogenicity of the mRNA vaccine BNT162b2 in patients with idiopathic pulmonary fibrosis. ERJ Open Res. Published online May 3, 2022. doi:10.1183/23120541.00082-2022