Antibody responses after documented COVID-19 disease in patients with autoimmune rheumatic disease

Abstract

Patients with autoimmune rheumatic diseases (AIRD) are suspected to have less robust immune responses during COVID-19 due to underlying immune dysfunction and the use of immune-suppressive drugs. Fifty consecutive patients with a diagnosis of AIRD on disease-modifying drugs were included at around 30 days after a confirmatory test for COVID-19. Fifty controls matched one to one for age, sex, and severity of COVID-19 were also included at around 30 days after testing positive for COVID-19. Antibody titers for anti-spike protein IgG and anti-nucleocapsid protein IgG were estimated. Cases (mean age 45.9 ± 13; 76% females) and controls (mean age 45.9 ± 13; 76% females) had similar proportion of comorbidities. Of the cases, 4 had moderate and 1 had severe COVID-19, while 3 and 1 of controls had moderate and severe COVID-19 respectively. Positivity of anti-N IgG was similar between patients (80%) and controls (90%) (p = 0.26). Similarly, anti-S IgG was positive in 82% of patients and 86% of controls (p = 0.79). Both the antibodies were negative in seven (14%) patients and five (10%) of controls (p = 0.76, Fischer exact test). Only anti-N IgG titers were lower in patients as compared to controls. In four patients with rheumatoid arthritis, two with spondyloarthritis and one with eosinophilic fasciitis both antibodies were not detectable. They did not differ from the rest of the cohort in clinical characteristics. The patients with AIRD had adequate protective antibody responses to COVID-19 at a median of 30 days post-infection. Thus, the presence of AIRD or the use of immunosuppressants does not seem to influence the development of humoral immune response against COVID-19. Key Points • Patients with autoimmune rheumatic diseases (AIRD) are suspected to have less robust immune responses. • In our cohort of 50 patients with AIRD with confirmed COVID-19, only seven did not have detectable protective antibodies at 30 days post infection. • Patients with AIRD on immunosuppressants have adequate protective antibodies post COVID-19 disease, at rates similar to that in health controls.

Hybrid immunity versus vaccine-induced immunity against SARS CoV2 in Patients with Autoimmune Rheumatic Diseases

“…We had previously shown that patients with AIRD also form adequate humoral responses to COVID-19 infection equivalent to those in healthy controls[16]. The current data shows that this can be augmented with a single dose of vaccine to produce a strong humoral immune response.…”

“…Our cohort comprises patients with AIRD registered with our centre (CARE – Centre for Arthritis and Rheumatism Excellence). We have been following up AIRD patients who have had COVID-19 infections [16] and those who have received vaccines [17]. Serum and plasma samples of these patients have been stored for future research with patients’ informed consent.…”

“…However, drugs like Rituximab have also been shown to be associated with lower rate of seroconversion post-vaccination[15]. We have previously shown that patients on immunosuppressive therapy respond similarly to the healthy controls following SARS-CoV-2 infection[16]. A small proportion of patients may experience flares of their autoimmune diseases following vaccination.…”

Hybrid immunity versus vaccine-induced immunity against SARS-CoV-2 in patients with autoimmune rheumatic diseases

“…We had previously shown that patients with autoimmune rheumatic diseases form anti-SARS-CoV-2 antibodies during COVID-19, equivalent to those in healthy controls. 9 The current data show that this can be augmented with a single dose of vaccine. A major concern was whether a natural infection would produce specific neutralising antibodies.…”

Immunosuppressant Treatment in Rheumatic Musculoskeletal Diseases Does Not Inhibit Elicitation of Humoral Response to SARS-CoV-2 Infection and Preserves Effector Immune Cell Populations

“…In the clinical practice, b/ts-DMARD or cs-DMARDs represent usual treatments for RMD patients, and there is concern whether their protracted use could cause a higher risk of developing a biased immune response upon SARS-CoV-2 infection due to the underlying immune system dysfunction. However, the incidence of COVID-19 in the RMD population was reported to be comparable to the general population (9,27), and seroprevalence to SARS-CoV-2 was similar between RMD patients and the general population after at least 1 month from infection (19,28).…”