Antibody development and disease severity of COVID-19 in non-immunised patients with rheumatic immune-mediated inflammatory diseases: data from a prospective cohort study

Laura Boekel, Femke Hooijberg, Erik H. Vogelzang, Yaëlle R. Besten, Maureen Leeuw, Sadaf Atiqi, Ronald F. van Vollenhoven, Carla A. Wijbrandts, Martijn Gerritsen, C. Krieckaert, Bas Dijkshoorn, Siham Bakhlakh, Juliette J. Crooijmans, Alexandre Voskuyl, Irene E. van der Horst-Bruinsma, Willem Lems, Taco W. Kuijpers, S. Marieke van Ham, Luuk Wieske, Filip EftimovLaura Y. Kummer, Pj Koos van Dam, Eileen W. Stalman, Maurice Steenhuis, Sofie Keijzer, Olvi Cristianawati, Jim Keijser, Floris C. Loeff, Sander W. Tas, Michael T. Nurmohamed, Maarten Boers, Theo Rispens, Gertjan Wolbink

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10 Citations (Scopus)


BACKGROUND: Research on the disease severity of COVID-19 in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) has been inconclusive, and long-term prospective data on the development of SARS-CoV-2 antibodies in these patients are lacking. METHODS: Adult patients with rheumatic IMIDs from the Amsterdam Rheumatology and Immunology Center, Amsterdam were invited to participate. All patients were asked to recruit their own sex-matched and age-matched control subject. Clinical data were collected via online questionnaires (at baseline, and after 1-4 and 5-9 months of follow-up). Serum samples were collected twice and analysed for the presence of SARS-CoV-2-specific antibodies. Subsequently, IgG titres were quantified in samples with a positive test result. FINDINGS: In total, 3080 consecutive patients and 1102 controls with comparable age and sex distribution were included for analyses. Patients were more frequently hospitalised compared with controls when infected with SARS-CoV-2; 7% vs 0.7% (adjusted OR: 7.33, 95% CI: 0.96 to 55.77). Only treatment with B-cell targeting therapy was independently associated with an increased risk of COVID-19-related hospitalisation (adjusted OR: 14.62, 95% CI: 2.31 to 92.39). IgG antibody titres were higher in hospitalised compared with non-hospitalised patients, and slowly declined with time in similar patterns for patients in all treatment subgroups and controls. INTERPRETATION: We observed that patients with rheumatic IMIDs, especially those treated with B-cell targeting therapy, were more likely to be hospitalised when infected with SARS-CoV-2. Treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs other than B-cell targeting agents is unlikely to have negative effects on the development of long-lasting humoral immunity against SARS-CoV-2.
Original languageEnglish
Article number002035
Issue number1
Publication statusPublished - 5 Apr 2022


  • Adult
  • COVID-19
  • COVID-19/epidemiology
  • Humans
  • Prospective Studies
  • Rheumatic Diseases/complications
  • SARS-CoV-2
  • Severity of Illness Index
  • antirheumatic agents
  • autoimmune diseases
  • biological therapy
  • epidemiology

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