Clinical and Experimental Vaccine Research

The Korean Vaccine Society (대한백신학회)
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Anti-severe acute respiratory syndrome coronavirus 2 spike receptor-binding domain antibody levels in patients with systemic lupus erythematosus based on vaccination status and related factors in Indonesia

  • Laniyati Hamijoyo (Rheumatology Division, Internal Medicine Department, Faculty of Medicine, Padjadjaran University) ;
  • Patrick Philo (Lupus Study Group, Immunology Study Center, Faculty of Medicine, Padjadjaran University) ;
  • Daniel Setiawan Nathan (Internal Medicine Department, Faculty of Medicine, Padjadjaran University) ;
  • Marita Restie Tiara (Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjadjaran University) ;
  • Sofie Razyanti Mardiana (Lupus Study Group, Immunology Study Center, Faculty of Medicine, Padjadjaran University) ;
  • Evan Susandi (Internal Medicine Department, Faculty of Medicine, Padjadjaran University) ;
  • Nadia Gita Ghassani (Lupus Study Group, Immunology Study Center, Faculty of Medicine, Padjadjaran University) ;
  • Bachti Alisjahbana (Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjadjaran University)
  • Received : 2024.09.21
  • Accepted : 2024.10.11
  • Published : 2024.10.31
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Abstract

Purpose: We aim to analyze the proportion and level of coronavirus disease 2019 (COVID-19) seropositivity in patients with systemic lupus erythematosus (SLE) and explore factors associated with lower anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (S-RBD) antibody levels. Materials and Methods: A cross-sectional study involving patients with SLE was conducted. We included those aged 18-60 years, either unvaccinated or had received inactivated vaccine (CoronaVac; Sinovac Biotech Ltd., China). Furthermore, participants were tested for anti-SARS-CoV-2 S-RBD antibody levels and SARS-CoV-2 surrogate virus neutralization test, and comparative test analysis was employed. Results: This study included 159 subjects of whom 92 and 67 were SLE subjects and controls, respectively. Significantly higher seropositive results were noted in patients with SLE receiving vaccine (96.9% versus 3.1%). Unvaccinated SLE patients receiving cyclophosphamide (CYC) had higher anti-RBD levels compared to unvaccinated SLE patients not receiving CYC (23.81 [interquartile range (IQR), 2.26-78.85] versus 2.13 [IQR, 0.1-12.5]), whereas vaccinated SLE patients receiving CYC had lower anti-RBD levels compared to vaccinated SLE patients not receiving CYC (15.5 [IQR, 6.62-35.09] and 69.77 [IQR, 17.48-201]). In the vaccinated SLE group, a lower value of anti-SARS-CoV-2 RBD antibody levels was observed in patients receiving mycophenolate mofetil and those with chronic kidney disease. No correlation was noted between disease activity and organ involvement with lower antibody response. Conclusion: The increase in COVID-19 antibody levels in patients with SLE may be affected by exposure to hospital settings and vaccine. Furthermore, CYC treatment is associated with lower antibody response after receiving vaccine.

Keywords

Acknowledgement

We are grateful for the support from Wondfo, Guanzhou Biotech, China and PT Biofarma Indonesia (Persero) for providing the FastBioRBD fluorescent immunoassay reader and the rapid test reagents for our study. Thank you to Research and Innovation Indonesian Institute (BRIN) for providing initial operational support for conducting the study. We thank the director of Hasan Sadikin General Hospital for allowing this study to be conducted and the staff of the hospital who participated in this study. We thank the Dean of the Medical Faculty of Padjadjaran University who provide laboratory facilities for sample management and testing in this study.

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