Patients with #IPF do not mount appreciable anti-spike antibody responses to two doses of #SARSCoV2 mRNA vaccine compared to the general population. National authorities should prioritise patients with IPF for booster doses.

The emergence and spread of 2019 coronavirus disease (COVID-19) are causing a growing global public health crisis. Despite advances in treatment, vaccination remains the best way to contain the pandemic [1]. Vaccines are available by means of conditional marketing approval, full approval and emergency use authorisation pathways [2]. Evidence suggest that immunocompromised individuals, including solid-organ transplant recipients and patients under immunosuppressive treatment, may have increased mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection despite double-dose mRNA vaccine regimens [3]. This is partially attributed to blunted immune responses to vaccination, since only 38–54% of kidney and liver transplant recipients developed detectable SARS-CoV-2 antibodies following the second dose of mRNA vaccines [3, 4].

Patients with idiopathic pulmonary fibrosis (IPF) present with disrupted cellular and humoral immune responses [5]. In view of previous data during the first waves of the pandemic indicating increased risk of death from COVID-19 in unvaccinated patients with fibrotic interstitial lung diseases (ILDs) [6], we aimed to determine humoral responses to two doses of SARS-CoV-2 BNT162b2 mRNA vaccine in patients with IPF and compare them to those seen in the general population.

Therefore, we conducted a multicentre, prospective study between 22 July 2021 and 31 October 2021 including patients who received a multidisciplinary diagnosis of IPF in five ILD centres in Greece, and age-matched controls. Prospective data collection and analysis was approved by the Institutional Review Board and the Local Ethics Committee (protocol number 18482/21–7-21). IPF was diagnosed based on American Thoracic Society/European Respiratory Society 2018 guidelines [7].

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