SARS-CoV-2 Antibody Isotypes in Systemic Lupus Erythematosus Patients Prior to Vaccination: Associations With Disease Activity, Antinuclear Antibodies, and Immunomodulatory Drugs During the First Year of the Pandemic

Abstract

ObjectivesImpact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on individuals with arthritis has been highlighted whereas data on other rheumatic diseases, e.g., systemic lupus erythematosus (SLE), are scarce. Similarly to SLE, severe SARS-CoV-2 infection includes risks for thromboembolism, an unbalanced type I interferon response, and complement activation. Herein, SARS-CoV-2 antibodies in longitudinal samples collected prior to vaccination were analyzed and compared with SLE progression and antinuclear antibody (ANA) levels.MethodsOne hundred patients (83 women) with established SLE and a regular visit to the rheumatologist (March 2020 to January 2021) were included. All subjects donated blood and had done likewise prior to the pandemic. SARS-CoV-2 antibody isotypes (IgG, IgA, IgM) to the cell receptor-binding S1-spike outer envelope protein were detected by ELISA, and their neutralizing capacity was investigated. IgG-ANA were measured by multiplex technology.ResultsDuring the pandemic, 4% had PCR-confirmed infection but 36% showed SARS-CoV-2 antibodies of ≥1 isotype; IgA was the most common (30%), followed by IgM (9%) and IgG (8%). The antibodies had low neutralizing capacity and were detected also in prepandemic samples. Plasma albumin (p = 0.04) and anti-dsDNA (p = 0.003) levels were lower in patients with SARS-CoV-2 antibodies. Blood group, BMI, smoking habits, complement proteins, daily glucocorticoid dose, use of hydroxychloroquine, or self-reported coronavirus disease 2019 (COVID-19) symptoms (except fever, >38.5°C) did not associate with SARS-CoV-2 antibodies.ConclusionOur data from early 2021 indicate that a large proportion of Swedish SLE patients had serological signs of exposure to SARS-CoV-2 but apparently with a minor impact on the SLE course. Use of steroids and hydroxychloroquine showed no distinct effects, and self-reported COVID-19-related symptoms correlated poorly with all antibody isotypes.

Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19

“…Approximately one tenth of the cohort had an immunosuppressive disorder, whereof two patients became critically ill and one with a newly diagnosed haematological malignancy deceased during the hospital stay. These findings are consistent with prior observations indicating a relatively low risk, compared to the general population, of severe COVID-19 due to immunosuppression (59)(60)(61)(62)(63). However, since not all patients with COVID-19 at the hospital were included in this study, definite conclusions cannot be drawn from the proportion of immunosuppressed relative to immunocompetent patients in the cohort.…”

SARS-CoV-2 seroprevalence, seroconversion and neutralizing antibodies in a systemic lupus erythematosus cohort and comparison to controls

“…In contrast, over a similar observation period, others reported that 4% (4/100) SLE patients had PCR-confirmed infection, but 36% showed SARS-CoV-2 antibodies of at least one isotype, particularly IgA and IgM. 2 However, these antibodies were also detected in pre-pandemic samples and had low neutralizing activity. We also measured IgM antibodies but found them to be an unreliable indicator of SARS-CoV-2 exposure and IgA cut-offs needed to be increased according to local controls.…”

“…It was unclear how these factors would alter B/T cell responses, risk of infection, and/or development of neutralizing antibodies. 2,3 In this study, we examined the prevalence of SARS-CoV-2 antibodies using multiple assays, RT-PCR positivity, and neutralizing antibodies in 173 SLE patients (94.8% female, mean age 48.5 years, mean disease duration 11.7 years, 42.8% non-White race/ethnicity, 83.2% prescribed hydroxychloroquine, 28.9% corticosteroids, and 43.9% other immunomodulators) prior to vaccination compared to controls.…”

Immunogenicity of Inactivated SARS-CoV-2 Vaccines in Patients With Rheumatoid Arthritis: A Case Series

“…In response to the SARS-CoV-2 outbreak and the resulting COVID-19 pandemic, a global competition to develop anti-COVID-19 vaccine has ensued ( 20 ). As the vaccination programs progress worldwide, the requirement of credible SARS-CoV-2 antibody assays (to demonstrate a successful vaccine response) will probably remain over the next couple of years ( 21 ). Previous studies have provided sufficient data on the safety and immunogenicity of vaccines in healthy individuals, with satisfactory results.…”