Robust long-term immunity to SARS-CoV-2 in patients recovered from severe COVID-19 after interleukin-6 blockade
Por:
Masia, M, Fernandez-Gonzalez, M, Garcia, J, Padilla, S, Garcia-Abellan, J, Botella, A, Mascarell, P, Agullo, V and Gutierrez, F
Publicada:
1 ago 2022
Ahead of Print:
1 jul 2022
Resumen:
Background Whether interleukin-6 (IL-6) blockade in patients with COVID-19 will affect the protective immunity against SARS-CoV-2 has become an important concern for anti-IL-6 therapy. We aimed to investigate the effects of IL-6 blockade on long-term immunity to SARS-CoV-2. Methods Prospective, longitudinal cohort study conducted in patients hospitalized for severe or critical COVID-19 with laboratory confirmed SARS-CoV-2 infection. We assessed humoral (anti-S1 domain of the spike [S], anti-nucleo-capsid [N], anti-trimeric spike [TrimericS] IgG, and neutralizing antibodies [Nab]) and T-cell (interferon -g release assay [IGRA]) responses and evaluated the incidence of reinfections over one year after infection in patients undergo-ing IL-6 blockade with tocilizumab and compared them with untreated subjects. Findings From 150 adults admitted with confirmed SARS-CoV-2 infection, 78 were 1:1 propensity score-matched. Patients receiving anti-IL6 therapy showed a shorter time to S-IgG seropositivity and stronger S-IgG and N-IgG anti-body responses. Among unvaccinated subjects one year after infection, median (Q1-Q3) levels of TrimericS-IgG (295 vs 121 BAU/mL; p = 0.011) and Nab (74.7 vs 41.0 %IH; p = 0.012) were higher in those undergoing anti-IL6 therapy, and a greater proportion of them had Nab (80.6% vs 57.7%; p = 0.028). T-cell immunity was also better in those treated with anti-IL6, with higher median (Q1-Q3) interferon -g responses (1760 [702-3992] vs 542 [35-1716] mIU/mL; p = 0.013) and more patients showing positive T-cell responses in the IGRA one year after infection. Patients treated with anti-IL6 had fewer reinfections during follow-up and responded to vaccination with robust increase in both antibody and T-cell immunity. Interpretation IL-6 blockade in patients with severe COVID-19 does not have deleterious effects on long-term immunity to SARS-CoV-2. The magnitude of both antibody and T-cell responses was stronger than the observed in non-anti-cytokine-treated patients with no increase in the risk of reinfections. Copyright (C) 2022 The Authors. Published by Elsevier B.V.
Filiaciones:
:
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
Hosp Gen Univ Elche, Infect Dis Unit, Cami Almazara 11, Elche 03203, Alicante, Spain
Univ Miguel Hernandez Elche, Clin Med Dept, Alicante, Spain
Univ Miguel Hernandez, Cami Almazara 11, Elche 03203, Alicante, Spain
Inst Salud Carlos III, CIBER Enfermedades Infecciosas, Madrid, Spain
:
Inst Salud Carlos III, CIBER Enfermedades Infecciosas, Madrid, Spain
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
:
Inst Salud Carlos III, CIBER Enfermedades Infecciosas, Madrid, Spain
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
:
Inst Salud Carlos III, CIBER Enfermedades Infecciosas, Madrid, Spain
Univ Miguel Hernandez Elche, Clin Med Dept, Alicante, Spain
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
:
Inst Salud Carlos III, CIBER Enfermedades Infecciosas, Madrid, Spain
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
:
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
:
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
:
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
Inst Salud Carlos III, CIBER Enfermedades Infecciosas, Madrid, Spain
:
Univ Miguel Hernandez, Cami Almazara 11, Elche 03203, Alicante, Spain
Hosp Gen Univ Elche, Infect Dis Unit, Cami Almazara 11, Elche 03203, Alicante, Spain
Inst Salud Carlos III, CIBER Enfermedades Infecciosas, Madrid, Spain
Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
Univ Miguel Hernandez Elche, Clin Med Dept, Alicante, Spain
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