Antibody development and disease severity of COVID-19 in non-immunised patients with rheumatic immune-mediated inflammatory diseases: data from a prospective cohort study

• Published in: Rheumatic & musculoskeletal diseases open 2022-04, Vol.8 (1), p.e002035
• Main Authors: Boekel, Laura, Hooijberg, Femke, Vogelzang, Erik H, Besten, Yaëlle R, Leeuw, Maureen, Atiqi, Sadaf, van Vollenhoven, Ronald F, Wijbrandts, Carla A, Gerritsen, Martijn, Krieckaert, C, Dijkshoorn, Bas, Bakhlakh, Siham, Crooijmans, Juliette J, Voskuyl, Alexandre, van der Horst-Bruinsma, Irene E, Lems, Willem, Kuijpers, Taco W, van Ham, S Marieke, Wieske, Luuk, Eftimov, Filip, Kummer, Laura Y, van Dam, PJ Koos, Stalman, Eileen W, Steenhuis, Maurice, Keijzer, Sofie, Cristianawati, Olvi, Keijser, Jim, Loeff, Floris C, Tas, Sander W, Nurmohamed, Michael T, Boers, Maarten, Rispens, Theo, Wolbink, Gertjan
• Format: Article
• Language: English
• Subjects: Adult; Antibodies; antirheumatic agents; autoimmune diseases; biological therapy; Cohort analysis; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 vaccines; Disease prevention; Drugs; Dyspnea; epidemiology; Hospitalization; Humans; Immunosuppressive agents; Infections; Inflammatory diseases; Medical research; Pandemics; Patients; Prospective Studies; Questionnaires; Research centers; Rheumatic diseases; Rheumatic Diseases - complications; Rheumatoid arthritis; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Tumor necrosis factor-TNF
• ISSN: 2056-5933; 2056-5933
• DOI: 10.1136/rmdopen-2021-002035

BackgroundResearch on the disease severity of COVID-19 in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) has been inconclusive, and long-term prospective data on the development of SARS-CoV-2 antibodies in these patients are lacking.MethodsAdult patients with rheumatic IMIDs from the Amsterdam Rheumatology and Immunology Center, Amsterdam were invited to participate. All patients were asked to recruit their own sex-matched and age-matched control subject. Clinical data were collected via online questionnaires (at baseline, and after 1–4 and 5–9 months of follow-up). Serum samples were collected twice and analysed for the presence of SARS-CoV-2-specific antibodies. Subsequently, IgG titres were quantified in samples with a positive test result.FindingsIn total, 3080 consecutive patients and 1102 controls with comparable age and sex distribution were included for analyses. Patients were more frequently hospitalised compared with controls when infected with SARS-CoV-2; 7% vs 0.7% (adjusted OR: 7.33, 95% CI: 0.96 to 55.77). Only treatment with B-cell targeting therapy was independently associated with an increased risk of COVID-19-related hospitalisation (adjusted OR: 14.62, 95% CI: 2.31 to 92.39). IgG antibody titres were higher in hospitalised compared with non-hospitalised patients, and slowly declined with time in similar patterns for patients in all treatment subgroups and controls.InterpretationWe observed that patients with rheumatic IMIDs, especially those treated with B-cell targeting therapy, were more likely to be hospitalised when infected with SARS-CoV-2. Treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs other than B-cell targeting agents is unlikely to have negative effects on the development of long-lasting humoral immunity against SARS-CoV-2.