Santana FM, Lopes JB, Perez MO, Campana G, Levi JE, Lopes FPPL, Gebara OE, Cobra JF and Figueiredo CP
Introduction: There is a lack of information on how immunomodulatory drugs for autoimmune rheumatic diseases (ARDs) impair humoral immune response following SARS-CoV-2 exposure.
Methods: A prospective study was performed with ARD patients on synthetic or biologic DMARDs (sDMARDs or bDMARDs) classified into three groups (antimalarial monotherapy, antimalarial plus bDMARD, antimalarial plus sDMARD) and a fourth group (control). All patients underwent a clinical baseline interview, anti-SARS-CoV-2 IgG/IgM tests at baseline and three months later, monitored for incident respiratory symptoms at follow-up, with rRT-PCR in suspected cases.
Results: One hundred patients were included. Fewer than half who turned IgG positive (42.8%) remained asymptomatic. All three positive rRT-PCR patients showed seroconversion for anti-SARS-CoV-2 IgG. There was also a trend for significant association for more frequent use of bDMARDs in IgG-positive patients (42.9% vs. 19.8%, p=0.056). Although patients on bDMARDs were also on antimalarial drugs, most of the patients who were not on bDMARDs were also on antimalarial drugs (group 1 and 3). Hence antimalarial use was widely present in both comparator groups. On the other hand, none of the patients on non-antimalarial sDMARD had detectable anti-SARS-CoV-2 IgG compared to 35.4% the remaining sample (0.0% vs. 35.4%, p=0.050).
Conclusion: Although anti-SARS-CoV-2 IgG positivity was quite common (14% incidence), half evolved asymptomatically. Temporally withholding bDMARD therapy in ARD patients during the pandemic based on possible humoral response impairment seems not suitable. sDMARD was associated with a lower incidence of anti-SARS-CoV-2 IgG positivity, although the study was not properly designed to clarify this matter.
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