Do COVID-19 vaccines work in immune suppressed people?

Posted on: 14th March 2023

Results from the Melody study show that most people who have had a liver transplant responded well to COVID-19 vaccines. The study also found a response in most people with rare autoimmune conditions. The simple test used in the study could help to find people at higher risk from COVID-19.

What did the study do?

The Melody study was run by doctors and researchers from Imperial College London, the NHS, and a range of health charities. It worked with people who are immunosuppressed and found out if they produced antibodies against COVID-19 after having the vaccines.

In June 2022 we put out a call for liver transplant recipients to join the trial. In total, nearly 10,000 transplant recipients took part in the study. Including 1,981 people who had had a liver transplant. The study also looked at people with a range of rare autoimmune conditions.

People taking part in the study had already had at least 3 doses of a COVID-19 vaccine. For the study they were sent a home antibody test kit. They used this to find out if they had antibodies against COVID-19 in their blood. Then reported the results to the researchers.

What did the study find for people who have had a liver transplant?

The study found that most of the people who took part had antibodies against COVID-19 in their blood.

Almost 8 in 10 (77%) people who had had a transplant had the antibodies.

When the researchers looked just at people who have had a liver transplant this number was a bit higher. More than 8 in 10 (85%) had antibodies.

What did the study find for people who have an autoimmune condition?

The study did not look at autoimmune liver conditions. But it did look at the impact of some immunosuppressant medicines used in some other rare autoimmune conditions. Some of these medicines are also used by people with autoimmune hepatitis (AIH).

More than 9 in 10 people taking azathioprine (91%) or methotrexate (92%) had antibodies against COVID-19.

More than 8 in 10 (82%) people taking steroids to treat their condition had the antibodies.

What does this mean for me?

The last few years have been a worrying time for many people. The arrival of COVID-19 vaccines made a huge difference. But it has not been clear how well they work for people who are immunosuppressed.

The Melody study helps to answer this question.

Having antibodies in your blood, means that your body can respond fast if you catch COVID-19. So, you are less likely to become seriously ill.

But it is worth remembering that this kind of study only gives us an average. Having almost 2,000 liver transplant recipients makes it a strong piece of research. But If 8 in 10 have antibodies, that means that 2 in 10 do not. These results cannot say for sure which of those groups you will be in.

The study also looked at other things that could change how well the vaccine works. It found that people are more likely to have COVID-19 antibodies if they:

  • Are younger
  • Have had more than 3 vaccine doses
  • Have had COVID-19 before
  • Take fewer immunosuppressant medicines

The type of vaccine people had also made a bit of a difference. The Oxford AstraZeneca vaccine didn’t work as well as the RNA vaccines in people who had had a transplant.

People who have had a transplant are less likely to make antibodies if they are taking three immunosuppressant drugs rather than one or two.

It is hard to know for sure who will respond well to a vaccine. So the researchers suggest offering an antibody test to people who might be at more risk. This could help to find those who need more boosters.

What should I do now?

If you have had all your COVID-19 vaccines, then you don’t need to do anything else. We don’t know yet how long the antibodies last. And having more vaccines seems to make it more likely you will have antibodies. So make sure you have any boosters you are offered.

What do we still need to find out?

This study only asked if the antibodies are there. The test used isn’t sensitive enough to find very low levels of antibody. It also can’t tell us how much antibody there is. This might be important. Other research is underway that should tell us more.

It also didn’t look at other parts of the immune system. Your immune system is very complicated and has lots of different parts. So, it is possible that people might have some protection from the vaccine, even if they do not make antibodies.

You can find out more about COVID-19, and about the vaccines and early treatments for people with a liver condition here.

The scientific paper published by the melody study team is available to anyone here.