原发性 SARS-CoV-2 感染在免疫介导的炎症性疾病患者中的情况：长期体液免疫反应及其对疾病活动的影响。
Primary SARS-CoV-2 infection in patients with immune-mediated inflammatory diseases: long-term humoral immune responses and effects on disease activity.
机构信息
Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
BMC Infect Dis. 2023 May 17;23(1):332. doi: 10.1186/s12879-023-08298-6.
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
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.
背景
接受免疫抑制剂 (ISPs) 治疗的免疫介导的炎症性疾病 (IMIDs) 患者在感染 SARS-CoV-2 后可能会出现长期体液免疫反应受损和疾病活动增加。我们旨在研究未接种疫苗的接受 ISP 治疗的 IMID 患者在初次 SARS-CoV-2 感染后的长期 SARS-CoV-2 体液免疫反应和疾病活动增加情况。
方法
本研究纳入了一项正在进行的前瞻性队列研究 (T2B! 研究) 中接受 ISPs 积极治疗的 IMID 患者和对照 (即未接受 ISP 治疗的 IMID 患者和健康对照)，这些患者在首次接种疫苗前已确诊 SARS-CoV-2 感染。通过电子调查和健康记录登记感染和疾病活动增加的临床数据。在首次接种疫苗前采集血清样本，以测量 SARS-CoV-2 抗受体结合域 (RBD) 抗体。
结果
共纳入 193 名接受 ISP 治疗的 IMID 患者和 113 名对照。185 名参与者的血清样本可用，感染与样本采集之间的中位时间为 173 天。接受 ISPs 治疗的 IMID 患者的血清阳性率为 78%，而对照组为 100%（p<0.001）。与其他 ISPs 相比，接受抗 CD20（40.0%）和抗肿瘤坏死因子 (TNF) 药物（60.5%）治疗的患者血清阳性率最低（p<0.001 和 p<0.001）。260 名患者中有 68 名（26.2%；95%CI 21.2-31.8%）报告感染后疾病活动增加，其中 6 名（8.8%）患者需要强化 ISP 治疗。
结论
接受 ISPs 治疗的 IMID 患者在初次 SARS-CoV-2 感染后出现长期体液免疫反应下降，主要归因于抗 CD20 和抗 TNF 药物治疗。感染后疾病活动增加的报告很常见，但大多为轻度。
临床试验注册
NL74974.018.20，试验 ID：NL8900。于 2020 年 9 月 9 日注册。
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