Impact of systemic therapies on SARS-CoV-2 antibody seroprevalence in patients with immune-mediated diseases

Objective To determine the seroprevalence of SARS-CoV-2 in patients with immune-mediated inflammatory diseases (IMID) treated with biologic (bDMARDs) or synthetic targeted disease-modifying antirheumatic drugs (tsDMARDs). Methods An observational, descriptive, prospective and cross-sectional study of analytical prevalence analysis was conducted in patients with IMID with bDMARDs or tsDMARDs. Seroprevalence was compared by measuring immunoglobulin G (IgG) against SARS-CoV-2 between October/2020 and May/2021. Results A total of 550 IMID`s patients were studied, all of them on treatment with bDMARDs or tsDMARDs. The seroprevalence of the total patient group was 16% (88/550). Patients receiving therapy with tumor necrosis factor alpha inhibitors (TNFi) had a higher seroprevalence compared to other biologic and synthetic targeted therapies (OR 1.792, [95% CI 1.088−2.951]; p = 0.021). The influence on seroprevalence of concomitant use with b/tsDMARDs of conventional synthetic DMARDs (csDMARDs) was also analyzed. A lower seroprevalence was demonstrated in the group of patients treated with TNFi and methotrexate together, compared with those on TNFi monotherapy, 10.1 vs. 24.1%, (OR 0.355, [95% CI 0.165−0.764]; p = 0.006). No significant differences were found with the other DMARDs. Regarding IMIDs, no differences in seroprevalence were identified between the different disease groups. Conclusion Patients on treatment with TNFα inhibitors have better humoral response compared to the other b/tsDMARDs, however, when associated with methotrexate the seroprevalence decreases significantly.