To investigate the impact of biological DMARD treatment on the prevalence, seroconversion rate and longevity of the humoral immune response against SARS-CoV-2 in IMID patients.
Anti-SARS-CoV-2 IgG antibodies were measured in a prospective cohort of healthcare and non-healthcare controls and IMID patients receiving no treatment or treated with conventional or biological DMARDs during the first and second COVID-19 waves. Regression models adjusting for age, sex, sampling-time and exposure risk behavior were used for calculating relative risks of seropositivity. Seroconversion rates were assessed in participants with PCR-proven SARS-CoV-2 infection. Antibody response longevity was evaluated by re-assessing participants who tested positive during the first wave.
4508 participants (2869 IMID patients, 1639 total controls) were analyzed. Unadjusted (RR 0.44; 95% CI: 0.31-0.62) and adjusted (RR 0.50; 95% CI: 0.34-0.73) relative risks for SARS-CoV2 IgG were significantly (p<0.001) lower in IMID patients treated with bDMARDs compared to non-healthcare controls, primarily driven by TNF-alpha, IL-17 and IL-23 inhibitors-treated patients. Adjusted relative risks of untreated IMID patients (1.12; 0.75-1.67) or IMID patients receiving csDMARDs (0.70; 0.45-1.08) were not significantly different from non-healthcare controls. Lack of seroconversion in PCR+ participants was more common (38.7%) among bDMARD-treated patients than in non-healthcare controls (16%). Overall 44% of positive participants lost SARS-CoV2 antibodies at 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. This article is protected by copyright. All rights reserved.