Primary SARS-CoV-2 infection in patients with immune-mediated inflammatory diseases: long-term humoral immune responses and effects on disease activity
van Dam, Koos P.J.; Volkers, Adriaan G.; Wieske, Luuk; Stalman, Eileen W.; Kummer, Laura Y.L.; van Kempen, Zoé L.E.; Killestein, Joep; Tas, Sander W.; Boekel, Laura; Wolbink, Gerrit J.; van der Kooi, Anneke J.; Raaphorst, Joost; Takkenberg, R. Bart; D’Haens, Geert R.A.M.; Spuls, Phyllis I.; Bekkenk, Marcel W.; Musters, Annelie H.; Post, Nicoline F.; Bosma, Angela L.; Hilhorst, Marc L.; Vegting, Yosta; Bemelman, Frederike J.; Voskuyl, Alexandre E.; Broens, Bo; Sanchez, Agner Parra; van Els, Cécile A.C.M.; de Wit, Jelle; Rutgers, Abraham; de Leeuw, Karina; Horváth, Barbara; Verschuuren, Jan J.G.M.; Ruiter, Annabel M.; van Ouwerkerk, Lotte; van der Woude, Diane; Allaart, Renée C.F.; Teng, Y. K.Onno; van Paassen, Pieter; Busch, Matthias H.; Jallah, Papay B.P.; Brusse, Esther; van Doorn, Pieter A.; Baars, Adája E.; Hijnen, Dirk Jan; Schreurs, Corine R.G.; van der Pol, W. Ludo; Goedee, H. Stephan; Steenhuis, Maurice; Keijzer, Sofie; Keijser, Jim B.D.; Cristianawati, Olvi; on behalf of the T2B! Immunity against SARS-CoV-2 study group
(2023) BMC Infectious Diseases, volume 23, issue 1
(Article)
Abstract
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:
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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. Trial registration: NL74974.018.20, Trial ID: NL8900. Registered on 9 September 2020.
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Keywords: Antibodies, Autoimmune disease, Covid-19, Disease activity, Flare, Immune-mediated inflammatory diseases, Immunity, Immunosuppression, SARS-CoV-2, TNF, Infectious Diseases
ISSN: 1471-2334
Publisher: BioMed Central
Note: Publisher Copyright: © 2023, The Author(s).
(Peer reviewed)
