TY - JOUR
T1 - Evaluation of SARS-CoV-2 IgG antibody reactivity in patients with systemic lupus erythematosus
T2 - analysis of a multi-racial and multi-ethnic cohort
AU - NYU WARCOV Investigators
AU - Saxena, Amit
AU - Guttmann, Allison
AU - Masson, Mala
AU - Kim, Mimi Y.
AU - Haberman, Rebecca H.
AU - Castillo, Rochelle
AU - Scher, Jose U.
AU - Deonaraine, Kristina K.
AU - Engel, Alexis J.
AU - Belmont, H. Michael
AU - Blazer, Ashira D.
AU - Buyon, Jill P.
AU - Fernandez-Ruiz, Ruth
AU - Izmirly, Peter M.
AU - Adhikari, Samrachana
AU - Axelrad, Jordan
AU - Azar, Natalie
AU - Blank, Rebecca
AU - Brancato, Lenore
AU - Brodetskiy, Konstantin
AU - Cao, Lily
AU - Carlucci, Philip M.
AU - Carsons, Steven
AU - Chang, Miao
AU - Chang, Shannon
AU - Chen, Alan
AU - Colin, Michael
AU - Fried, Lauren
AU - Garner, Bruce
AU - Goldberg, Avram
AU - Golden, Brian
AU - Golpanian, Michael
AU - Haj-Ali, Mayce
AU - Hoey, Jessica
AU - Homsi, Yamen
AU - Hong, Simon
AU - Hudesman, David
AU - Hussain, Nazia
AU - Jaros, Brian
AU - Katz, Susan
AU - Kolla, Avani
AU - Lee, Euna
AU - Lee, Sicy
AU - Lesser, Robert
AU - Lipschitz, Robin
AU - Lydon, Eileen
AU - Malik, Fardina
AU - Mangalick, Keshav
AU - Mehta, Kavini
AU - Modi, Anang
N1 - Funding Information:
PMI and JPB received funding from the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant number P50 AR07059 ), and JUS and PMI received a Bloomberg Philanthropies COVID-19 Response Initiative Grant. No authors are employed by NIH. We thank all patients who participated in this study, despite the challenging circumstances. We are grateful to the clinicians from NYU Langone Health and NYC Health + Hospitals/Bellevue who referred patients to us. We thank Leora Horwitz for her assistance with the ICD-10 query at NYU. We also acknowledge Tania Moin and Ranit Shriky for assistance in navigating regulatory matters.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
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U2 - 10.1016/S2665-9913(21)00114-4
DO - 10.1016/S2665-9913(21)00114-4
M3 - Article
AN - SCOPUS:85111235719
VL - 3
SP - e585-e594
JO - The Lancet Rheumatology
JF - The Lancet Rheumatology
SN - 2665-9913
IS - 8
ER -