Clinical and immunological outcomes of SARS-CoV-2-infected vaccine responders, vaccine non-responders, and unvaccinated patients evaluated for neutralizing monoclonal antibody treatment at a single German tertiary care center: a retrospective cohort study with prospective follow-up.

Autor: Triebelhorn J; Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany. julian.triebelhorn@mri.tum.de., Schneider J; Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany., Spinner CD; Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany., Iakoubov R; Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany., Voit F; Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany., Wagner L; Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany., Erber J; Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany., Rothe K; Institute of Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany., Berthele A; Department of Neurology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany., Pernpeintner V; Department of Neurology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany., Strauß EM; Department of Neurology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany., Renders L; Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany., Willmann A; Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany., Minic M; Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany., Vogel E; Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany., Christa C; Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany., Hoffmann D; Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany., Protzer U; Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany., Jeske SD; Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany.
Jazyk: angličtina
Zdroj: Infection [Infection] 2024 Jun; Vol. 52 (3), pp. 1143-1151. Date of Electronic Publication: 2024 Feb 02.
DOI: 10.1007/s15010-023-02171-z
Abstrakt: Purpose: This study assessed the clinical and immunological outcomes of SARS-CoV-2-infected patients with risk factors for severe disease depending on their immunological status.
Methods: In this retrospective study with single follow-up visit, clinical outcome and humoral immunity was monitored in SARS-CoV-2 infected patients at risk. The results were compared based on the patients' initial immunological status: unvaccinated (UV), patients who did not develop neutralizing antibodies after vaccination (vaccine non-responders, VNR), and patients who expressed neutralizing antibodies after vaccination (vaccine responders, VR). Patients who lacked neutralizing antibodies (VNR and UV) were treated with nMABs.
Results: In total, 113 patients at risk of severe COVID-19 consented to participate in the study. VR and UV were not admitted to the hospital. During the observation period, UVs had the highest rate of SARS-CoV-2 re-infections. Three of 41 VNRs (7.3%) were hospitalized due to severe COVID-19, with two of them having undergone iatrogenic B-cell depletion. The humoral immune response after infection was significantly lower in the VNR group than in the VR group in terms of anti-N, anti-receptor-binding domain (RBD), anti-S antibody titers, and anti-S antibody avidity. In a sub-analysis of VNR, B cell-deficient non-responders had significantly lower levels of anti-N antibodies and anti-S avidity after infection than other VNRs.
Conclusion: VNR, particularly B-cell-depleted VNR, remained at risk of hospitalization due to COVID-19. In the VR group, however, no clinical complications or severe disease were observed, despite not receiving nMAbs. Tailoring the administration of nMABs according to patient vaccination and immunological status may be advisable.
(© 2024. The Author(s).)
Databáze: MEDLINE
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