Clinical and humoral response after SARS-CoV-2 breakthrough infection in patients receiving immunosuppressant therapy - 05/09/24
, Luuk Wieske, MD, PhD a, b, Jim B.D. Keijser, MSc c, Koos P.J. van Dam, MD a, Laura Y.L. Kummer, MD a, c, Maarten F. Wilbrink, Bsc a, Zoé L.E. van Kempen, MD, PhD d, Joep Killestein, MD, PhD d, Adriaan G. Volkers, MD, PhD e, Sander W. Tas, MD, PhD f, Laura Boekel, BSc f, Gerrit J. Wolbink, MD, PhD g, Anneke J. van der Kooi, MD, PhD a, Joost Raaphorst, MD, PhD a, Mark Löwenberg, MD, PhD e, R. Bart Takkenberg, MD, PhD e, Geert R.A.M. D’Haens, MD, PhD e, Phyllis I. Spuls, MD, PhD h, Marcel W. Bekkenk, MD, PhD h, Annelie H. Musters, MD h, Nicoline F. Post, MD h, Angela L. Bosma, MD h, Marc L. Hilhorst, MD, PhD i, Yosta Vegting, MD i, Frederique J. Bemelman, MD, PhD i, Alexandre E. Voskuyl, MD, PhD j, Bo Broens, MD j, Agner Parra Sanchez, MD f, j, Cécile A.C. M. van Els, PhD k, l, Jelle de Wit, PhD k, Abraham Rutgers, MD, PhD m, Karina de Leeuw, MD, PhD m, Barbara Horváth, MD, PhD n, Jan J.G.M. Verschuuren, MD, PhD o, Annabel M. Ruiter, MD o, Lotte van Ouwerkerk, MD p, Diane van der Woude, MD, PhD p, Renée C.F. Allaart, MD, PhD p, Y.K. Onno Teng, MD, PhD q, Pieter van Paassen, MD, PhD r, Matthias H. Busch, MD r, Esther Brusse, MD, PhD s, Pieter A. van Doorn, MD, PhD s, Adája E. Baars, MD s, Dirkjan Hijnen, MD, PhD t, Corine R.G. Schreurs, MD t, W. Ludo van der Pol, MD, PhD u, H. Stephan Goedee, MD, PhD u, Maurice Steenhuis, PhD c, Sofie Keijzer, MSc c, Olvi Cristianawati, PhD c, Anja ten Brinke, PhD c, Niels J.M. Verstegen, PhD c, Koos A.H. Zwinderman, PhD v, S. Marieke van Ham, PhD c, w, Theo Rispens, PhD c, Matthijs R. Welkers, MD, PhD x, Marcel Jonges, PhD x, Filip Eftimov, MD, PhD a, Taco W. Kuijpers, MD, PhD yon behalf of the
T2B! immunity against SARS-CoV-2 study group
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Background |
Despite impaired humoral response in patients treated with immunosuppressants (ISPs), recent studies found similar severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection compared to controls. One potential explanation is the rapid generation of humoral response on infection, but evidence is lacking.
Objectives |
We investigated the longitudinal dynamics of the SARS-CoV-2 antibody repertoire after SARS-CoV-2 delta and omicron breakthrough infection in patients with immune-mediated inflammatory diseases (IMIDs) receiving ISP therapy and controls.
Methods |
As a prospective substudy of the national Target-to-B! (T2B!) consortium, we included IMID patients receiving ISPs therapy and controls who reported SARS-CoV-2 breakthrough infection between July 1, 2021, and April 1, 2022. To get an impression of the dynamics of the antibody repertoire, 3 antibody titers of wild-type RBD, wild-type S, and omicron RBD were measured at 4 time points after SARS-CoV-2 breakthrough infection.
Results |
We included 302 IMID patients receiving ISPs and 178 controls. Antibody titers increased up to 28 days after breakthrough infection in both groups. However, in IMID patients receiving therapy with anti-CD20 and sphingosine-1 phosphate receptor modulators, antibody titers were considerably lower compared to controls. In the anti-TNF group, we observed slightly lower antibody titers in the early stages and a faster decline of antibodies after infection compared to controls. Breakthrough infections were mostly mild, and hospitalization was required in less than 1% of cases.
Conclusions |
Most ISPs do not influence the dynamics of the SARS-CoV-2 antibody repertoire and exhibit a rapid recall response with cross-reactive antibody clones toward new virus variants. However, in patients treated with anti-CD20 therapy or sphingosine-1 phosphate receptor modulators, the dynamics were greatly impaired, and to a lesser extent in those who received anti-TNF. Nevertheless, only a few severe breakthrough cases were reported.
Le texte complet de cet article est disponible en PDF.Key words : SARS-CoV-2, autoimmune disease, immunosuppressants, breakthrough infection, humoral response
Abbreviations used : COVID-19, ELISA, IMID, ISP, MMF, Omicron RBD, RBD, RiVM, S, S1P, SARS-CoV-2, T2B!, Wild-type RBD, Wild-type S
Plan
| The first 2 authors contributed equally to this article, and both should be considered first author. The last 2 authors contributed equally to this article, and both should be considered senior author. |
Vol 154 - N° 3
P. 754 - septembre 2024 Retour au numéro
Article précédent
- Integrin β1–mediated mast cell immune-surveillance of blood vessel content
- Kristina Link, Lina Muhandes, Anastasia Polikarpova, Tim Lämmermann, Michael Sixt, Reinhard Fässler, Axel Roers
- L-plastin associated syndrome of immune deficiency and hematologic cytopenia
- Raquel A. Hernandez, James I. Hearn, Vijay Bhoopalan, Abdul Rezzak Hamzeh, Kristy Kwong, Koula Diamand, Ainsley Davies, Fei-Ju Li, Harish Padmanabhan, Rachel Milne, Fiona Ballard, Dominik Spensberger, Elizabeth E. Gardiner, Bahar Miraghazadeh, Anselm Enders, Matthew C. Cook
Bienvenue sur EM-consulte, la référence des professionnels de santé.