{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T22:40:32Z","timestamp":1778539232928,"version":"3.51.4"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T00:00:00Z","timestamp":1658966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The antibody response after vaccination is impaired in common variable immunodeficiency (CVID).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to study the spike receptor-binding domain IgG antibody (anti-S-RBD) levels during a four-dose SARS-CoV-2 vaccination strategy and after monoclonal antibody (mAB) treatment in CVID. Moreover, we assessed the anti-S-RBD levels in immunoglobulin replacement therapy (IgRT) products.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In an observational study, we examined anti-S-RBD levels after the second, third, and fourth dose of mRNA SARS-CoV-2 vaccines. Moreover, we measured anti-S-RBD after treatment with mAB. Finally, anti-S-RBD was assessed in common IgRT products. Antibody non-responders (anti-S-RBD &amp;lt; 7.1) were compared by McNemar\u2019s test and anti-S-RBD levels were compared with paired and non-paired Wilcoxon signed rank tests as well as Kruskal\u2013Wallis tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 33 individuals with CVID, anti-S-RBD levels increased after the third vaccine dose (165 BAU\/ml [95% confidence interval: 85; 2280 BAU\/ml], <jats:italic>p<\/jats:italic> = 0.006) and tended to increase after the fourth dose (193 BAU\/ml, [\u221222; 569 BAU\/ml], <jats:italic>p<\/jats:italic> = 0.080) compared to the previous dose. With increasing number of vaccinations, the proportion of patients who seroconverted (anti-S-RBD \u2265 7.1) increased non-significantly. mAB treatment resulted in a large increase in anti-S-RBD and a higher median level than gained after the fourth dose of vaccine (<jats:italic>p<\/jats:italic> = 0.009). IgRT products had varying concentrations of anti-S-RBD (<jats:italic>p<\/jats:italic> &amp;lt; 0.001), but none of the products seemed to affect the overall antibody levels (<jats:italic>p<\/jats:italic> = 0.460).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Multiple SARS-CoV-2 vaccine doses in CVID seem to provide additional protection, as antibody levels increased after the third and fourth vaccine dose. However, anti-S-RBD levels from mAB outperform the levels mounted after vaccination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>Boosting with SARS-CoV-2 vaccines seems to improve the antibody response in CVID patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Capsule summary<\/jats:title><jats:p>The third and possibly also the fourth dose of mRNA SARS-CoV-2 vaccine in CVID improve the antibody response as well as stimulate seroconversion in most non-responders.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2022.934476","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T05:55:15Z","timestamp":1658987715000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Antibody response following the third and fourth SARS-CoV-2 vaccine dose in individuals with common variable immunodeficiency"],"prefix":"10.3389","volume":"13","author":[{"given":"Bibi 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