Abstract
COVID-19 has proven to be particularly serious and life-threatening for patients presenting with pre-existing pathologies. Patients affected by rheumatic musculoskeletal disease (RMD) are likely to have impaired immune responses against SARS-CoV-2 infection due to their compromised immune system and the prolonged use of disease-modifying anti-rheumatic drugs (DMARDs), which include conventional synthetic (cs) DMARDs or biologic and targeted synthetic (b/ts) DMARDs. To provide an integrated analysis of the immune response following SARS-CoV-2 infection in RMD patients treated with different classes of DMARDs we carried out an immunological analysis of the antibody responses toward SARS-CoV-2 nucleocapsid and RBD proteins and an extensive immunophenotypic analysis of the major immune cell populations. We showed that RMD individuals under most DMARD treatments mount a sustained antibody response to the virus, with neutralizing activity. In addition, they displayed a sizable percentage of effector T and B lymphocytes. Among b-DMARDs, we found that anti-TNFα treatments are more favorable drugs to elicit humoral and cellular immune responses as compared to CTLA4-Ig and anti-IL6R inhibitors. This study provides a whole picture of the humoral and cellular immune responses in RMD patients by reassuring the use of DMARD treatments during COVID-19. The study points to TNF-α inhibitors as those DMARDs permitting elicitation of functional antibodies to SARS-CoV-2 and adaptive effector populations available to counteract possible re-infections.
Keywords: COVID-19; DMARD; immune responses; inflammatory arthritis; rheumatic musculoskeletal diseases.
【저자키워드】 COVID-19, immune responses, Inflammatory arthritis, DMARD, rheumatic musculoskeletal diseases., 【초록키워드】 Treatment, SARS-CoV-2, Arthritis, immune response, Diseases, adaptive, antibody, Cellular immune response, SARS-COV-2 infection, Antibody Response, drug, immune system, virus, inhibitors, immune, Population, Neutralizing activity, Antibody responses, immune responses, Patient, Inflammatory arthritis, inhibitor, Pathologies, disease, RBD protein, biologic, Humoral and cellular immune responses, TNF-α, Analysis, Inflammatory, Disease-modifying anti-rheumatic drugs, humoral, Re-infections, B lymphocytes, Musculoskeletal, individual, life-threatening, CTLA4, SARS-CoV-2 nucleocapsid, RBD proteins, immune cell populations, immunological, affected, carried, include, addition, functional, provide, elicit, presenting, sustained, the antibody response, disease-modifying anti-rheumatic drug, patients treated, 【제목키워드】 SARS-CoV-2, Population, response, Immunosuppressant, effector,