Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
Rheumatology Clinical Practice Erlangen, Germany.
Arthritis Rheumatol. 2022 May;74(5):783-790. doi: 10.1002/art.42035. Epub 2022 Mar 23.
To investigate the impact of biologic disease-modifying antirheumatic drug (bDMARD) treatment on the prevalence, seroconversion rate, and longevity of the humoral immune response against SARS-CoV-2 in patients with immune-mediated inflammatory diseases (IMIDs).
Anti-SARS-CoV-2 IgG antibodies were measured in a prospective cohort of health care professional controls and non-health care controls and IMID patients receiving no treatment or receiving treatment with conventional or biologic DMARDs during the first and second COVID-19 waves. Regression models adjusting for age, sex, sampling time, and exposure risk behavior were used to calculate relative risks (RRs) of seropositivity. Seroconversion rates were assessed in participants with polymerase chain reaction (PCR)-positive SARS-CoV-2 infection. Antibody response longevity was evaluated by reassessing participants who tested positive during the first wave.
In this study, 4,508 participants (2,869 IMID patients and 1,639 controls) were analyzed. The unadjusted RR (0.44 [95% confidence interval (95% CI) 0.31-0.62]) and adjusted RR (0.50 [95% CI 0.34-0.73]) for SARS-CoV-2 IgG antibodies were significantly lower in IMID patients treated with bDMARDs compared to non-health care controls (P < 0.001), primarily driven by treatment with tumor necrosis factor inhibitors, interleukin-17 (IL-17) inhibitors, and IL-23 inhibitors. Adjusted RRs for untreated IMID patients (1.12 [95% CI 0.75-1.67]) and IMID patients receiving conventional synthetic DMARDs (0.70 [95% CI 0.45-1.08]) were not significantly different from non-health care controls. Lack of seroconversion in PCR-positive participants was more common among bDMARD-treated patients (38.7%) than in non-health care controls (16%). Overall, 44% of positive participants lost SARS-CoV-2 antibodies by follow-up, with higher rates in IMID patients treated with bDMARDs (RR 2.86 [95% CI 1.43-5.74]).
IMID patients treated with bDMARDs have a lower prevalence of SARS-CoV-2 antibodies, seroconvert less frequently after SARS-CoV-2 infection, and may exhibit a reduced longevity of their humoral immune response.
研究生物改善病情抗风湿药物（bDMARD）治疗对免疫介导的炎症性疾病（IMID）患者对 SARS-CoV-2 的体液免疫应答的流行率、血清转化率和寿命的影响。
在首次和第二次 COVID-19 浪潮期间，对接受常规或生物 DMARD 治疗或未接受治疗的健康护理专业对照者和 IMID 患者进行前瞻性队列研究，以测量抗 SARS-CoV-2 IgG 抗体。使用调整年龄、性别、采样时间和暴露风险行为的回归模型来计算血清阳性的相对风险（RR）。在聚合酶链反应（PCR）阳性 SARS-CoV-2 感染的参与者中评估血清转化率。通过重新评估在第一次浪潮中检测为阳性的参与者来评估抗体反应的持久性。
在这项研究中，分析了 4508 名参与者（2869 名 IMID 患者和 1639 名对照者）。与非健康护理对照者相比，接受 bDMARD 治疗的 IMID 患者的 SARS-CoV-2 IgG 抗体的未调整 RR（0.44 [95%置信区间（95%CI）0.31-0.62]）和调整 RR（0.50 [95%CI 0.34-0.73]）显著降低（P < 0.001），主要是由肿瘤坏死因子抑制剂、白细胞介素-17（IL-17）抑制剂和 IL-23 抑制剂治疗引起的。未经治疗的 IMID 患者（1.12 [95%CI 0.75-1.67]）和接受常规合成 DMARD 治疗的 IMID 患者（0.70 [95%CI 0.45-1.08]）的调整 RR 与非健康护理对照者无显著差异。PCR 阳性参与者中缺乏血清转化率在 bDMARD 治疗患者（38.7%）中比非健康护理对照者（16%）更为常见。总体而言，44%的阳性参与者在随访中失去了 SARS-CoV-2 抗体，bDMARD 治疗的 IMID 患者的比率更高（RR 2.86 [95%CI 1.43-5.74]）。
接受 bDMARD 治疗的 IMID 患者 SARS-CoV-2 抗体的流行率较低，感染 SARS-CoV-2 后血清转化率较低，体液免疫应答的寿命可能较短。
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