Evaluation of SARS-CoV-2 IgG antibody reactivity in patients with systemic lupus erythematosus: analysis of a multi-racial and multi-ethnic cohort. (August 2021)

• Record Type: Journal Article
• Authors: Saxena, Amit; Guttmann, Allison; Masson, Mala; Kim, Mimi Y; Haberman, Rebecca H; Castillo, Rochelle; Scher, Jose U; Deonaraine, Kristina K; Engel, Alexis J; Belmont, H Michael; Blazer, Ashira D; Buyon, Jill P; Fernandez-Ruiz, Ruth; Izmirly, Peter M; Adhikari, Samrachana; Axelrad, Jordan; Azar, Natalie; Blank, Rebecca; Brancato, Lenore; Brodetskiy, Konstantin; Cao, Lily; Carlucci, Philip M.; Carsons, Steven; Chang, Miao; Chang, Shannon; Chen, Alan; Colin, Michael; Fried, Lauren; Garner, Bruce; Goldberg, Avram; Golden, Brian; Golpanian, Michael; Haj-Ali, Mayce; Hoey, Jessica; Homsi, Yamen; Hong, Simon; Hudesman, David; Hussain, Nazia; Jaros, Brian; Katz, Susan; Kolla, Avani; Lee, Euna; Lee, Sicy; Lesser, Robert; Lipschitz, Robin; Lydon, Eileen; Malik, Fardina; Mangalick, Keshav; Mehta, Kavini; Modi, Anang; Neimann, Andrea; Novack, Joshua; Nusbaum, Julie; Peterson, Connor; Piatti, Andres; Plotz, Benjamin; Porges, Andrew; Quintana, Lindsey; Rackoff, Paula; Ramirez, Deborah; Rangel, Lauren; Reddy, Soumya; Robins, Kimberly; Rosenthal, Pamela; Samuels, Jonathan; Sandigursky, Sabina; Sekar, Vaish; Shankar, Shruti; Shen, Harry; Smiles, Stephen; Smuda, Craig; Solitar, Bruce; Solomon, Gary; Stein, Jennifer; Steuer, Alexa; Sullivan, Janine; Svigos, Katerina; Troxel, Andrea; Viennas, Stelios; Wong, Lauren; Yan, Di; Yin, Kaitlyn (Lu); Young, Trevor; Zagon, Gary;
• Is Part Of: Lancet. Volume 3:Number 8(2021)
• Page Start: e585
• Page End: e594
• Publication Date: 2021-08
• Subjects: Rheumatology -- periodicals; 616.72305
• DOI: 10.1016/S2665-9913(21)00114-4
• Languages: English
• ISSNs: 2665-9913

Abstract

Summary: Background: Patients with systemic lupus erythematosus (SLE) are at risk of developing COVID-19 due to underlying immune abnormalities and regular use of immunosuppressant medications. We aimed to evaluate the presence of SARS-CoV-2 IgG antibodies in patients with SLE with or without previous COVID-19-related symptoms or RT-PCR-confirmed SARS-CoV-2 infection. Methods: For this analysis, we included patients with SLE from two cohorts based in New York City: the Web-based Assessment of Autoimmune, Immune-Mediated and Rheumatic Patients during the COVID-19 pandemic (WARCOV) study; and the NYU Lupus Cohort (a prospective registry of patients at NYU Langone Health and NYC Health + Hospitals/Bellevue). Patients in both cohorts were tested for SARS-CoV-2 IgG antibodies via commercially available immunoassays, processed through hospital or outpatient laboratories. Patients recruited from the NYU Lupus Cohort, referred from affiliated providers, or admitted to hospital with COVID-19 were tested for SARS-CoV-2 IgG antibodies as part of routine surveillance during follow-up clinical visits. Findings: 329 patients with SLE were included in this analysis, 146 from the WARCOV study and 183 from the NYU Lupus Cohort, and were tested for SARS-CoV-2 antibodies between April 29, 2020, and Feb 9, 2021. 309 (94%) were women and 91 (28%) were of Hispanic ethnicity. 51 (16%) of 329 patients had a positive SARS-CoV-2 IgG antibody test. Seropositive patients were more likely than seronegative patients to be Hispanic (24 [47%] of 51 vsz 67 [24%] of 278). Other demographic variables, SLE-specific factors, and immunosuppressant use were not associated with SARS-CoV-2 positivity. Of the 29 patients with COVID-19 previously confirmed by RT-PCR, 18 (62%) were on immunosuppressants; 24 (83%) of 29 patients tested positive for SARS-CoV-2 IgG antibodies. Of 17 patients who had symptoms of COVID-19 but negative concurrent RT-PCR testing, one (6%) developed an antibody response. Of 26 patients who had COVID-19-related symptoms but did not undergo RT-PCR testing, six (23%) developed an antibody response. Of 83 patients who had no symptoms of COVID-19 and no RT-PCR testing, four (5%) developed an antibody response. Among 36 patients who were initially SARS-CoV-2 IgG positive, the majority maintained reactivity serially (88% up to 10 weeks, 83% up to 20 weeks, and 80% up to 30 weeks). Seven (70%) of ten patients with confirmed COVID-19 had antibody positivity beyond 30 weeks from disease onset. Interpretation: Most patients with SLE and confirmed COVID-19 were able to produce and maintain a serological response despite the use of a variety of immunosuppressants, providing reassurance about the efficacy and durability of humoral immunity and possible protection against re-infection with SARS-CoV-2. Funding: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, and Bloomberg Philanthropies COVID-19 Response Initiative Grant.