COIOS
Tomorrow's world Item refines preprint

Immunosuppressed people are less protected than their antibody levels would suggest

A meta-analysis of antibody responses to mRNA COVID-19 vaccination found binding antibody levels 54.5-fold lower in people on B-cell depleting therapy than in healthy controls, and protection against infection and hospitalisation lower at any given antibody level.

The review pooled post-vaccination SARS-CoV-2 binding antibody levels in people with haematological malignancies, neurological disorders, rheumatic disease and other immune-mediated conditions on immunosuppressive therapy, alongside healthy controls. Levels were lowest with B-cell depletion, a 54.5-fold reduction (95% CI 34.5-86.2), and with S1P inhibitors, 24.8-fold (13.2-46.7). Linking predicted neutralising levels to earlier effectiveness estimates, protection tracked antibody level but sat lower in immunosuppressed people at any given level, in a preprint.

Why it is interesting: Antibody titre is the standard correlate of protection, and in this group it understates the risk that remains.

Source
medRxiv, 22 September 2026
DOI
10.64898/2026.09.16.26363194
Type
Preprint
Design
Systematic review and meta-analysis of post-mRNA-vaccination binding antibody levels across immunosuppressive therapy cohorts and healthy controls, linked to existing vaccine effectiveness estimates
Verdict
Refines prior evidence
Driver
Infection and pandemics