Primary SARS-CoV-2 infection in patients with immune-mediated inflammatory diseases: long-term humoral immune responses and effects on disease activity

Dam, K.P.J. van; Volkers, A.G.; Wieske, L.; Stalman, E.W.; Kummer, L.Y.L.; Kempen, Z.L.E. van; ... ; TB2 Immunity Sars-Cov-2 Study Grp (2023)

Article / Letter to editor

Background

Patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressants (ISPs) may have impaired long-term humoral immune responses and increased disease activity after SARS-CoV-2 infection. We aimed to investigate long-term humoral immune responses against SARS-CoV-2 and increased disease activity after a primary SARS-CoV-2 infection in unvaccinated IMID patients on ISPs.

Methods

IMID patients on active treatment with ISPs and controls (i.e. IMID patients not on ISP and healthy controls) with a confirmed SARS-CoV-2 infection before first vaccination were included from an ongoing prospective cohort study (T2B! study). Clinical data on infections and increased disease activity were registered using electronic surveys and health records. A serum sample was collected before first vaccination to measure SARS-CoV-2 anti-receptor-binding domain (RBD) antibodies.

Results

In total, 193 IMID patients on ISP and 113 controls were included. Serum samples from 185 participants were available, with a median time of 173 days between infection and sample collection. The rate of seropositive IMID patients on ISPs was 78% compared to 100% in controls (p < 0.001). Seropositivity rates were lowest in patients on anti-CD20 (40.0%) and anti-tumor necrosis factor (TNF) agents (60.5%), as compared to other ISPs (p < 0.001 and p < 0.001, respectively). Increased disease activity after infection was reported by 68 of 260 patients (26.2%; 95% CI 21.2–31.8%), leading to ISP intensification in 6 out of these 68 patients (8.8%).

Conclusion

IMID patients using ISPs showed reduced long-term humoral immune responses after primary SARS-CoV-2 infection, which was mainly attributed to treatment with anti-CD20 and anti-TNF agents. Increased disease activity after SARS-CoV-2 infection was reported commonly, but was mostly mild.

• SARS-CoV-2
• Covid-19
• Autoimmune disease
• Immune-mediated inflammatory diseases
• Immunosuppression
• TNF
• Immunity
• Antibodies
• Disease activity
• Flare

• All authors: Dam, K.P.J. van; Volkers, A.G.; Wieske, L.; Stalman, E.W.; Kummer, L.Y.L.; Kempen, Z.L.E. van; Killestein, J.; Tas, S.W.; Boekel, L.; Wolbink, G.J.; Kooi, A.J. van der; Raaphorst, J.; Takkenberg, R.B.; D'Haens, G.R.A.M.I.; Spuls, P.W.; Bekkenk, M.H.; Musters, A.F.; Post, N.L.; Bosma, A.L.; Hilhorst, M.; Vegting, Y.J.; Bemelman, F.E.; Voskuyl, A.; Broens, B.; Sanchez, A.P.; Els, C.A.C.M. van; Wit, J. de; Rutgers, A.; Leeuw, K. de; Horváth, B.; Verschuuren, J.J.G.M.M.; Ruiter, A.M.; Ouwerkerk, L. van; Woude, D. van der; Allaart, R.C.F.; Teng, Y.K.O.; Paassen, P.H. van; Busch, M.H.; Jallah, P.B.P.; Brusse, E.; Doorn, P.A. van; Baars, A.E.; Hijnen, D.J.; Schreurs, C.R.G.; Pol, W.L. van der; Goedee, H.S.; Steenhuis, M.; Keijzer, S.; Keijser, J.B.D.; Cristianawati, O.; Brinke, A. ten; Verstegen, N.J.M.; Ham, S.M. van; Rispens, T.W.; Kuijpers, T.; Löwenberg, M.; Eftimov, F.; TB2 Immunity Sars-Cov-2 Study Grp
• Date: 2023-05-17
• Journal: BMC Infectious Diseases
• Volume: 23
• Issue: 1
• DOI: doi:10.1186/s12879-023-08298-6
• Link: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08298-6