Anti-Spike Antibodies Protect Against COVID-19 Infection in Immune-Mediated Inflammatory Diseases: Findings from the SUCCEED Study

Jeremiah Tan¹, J. Antonio Avina-Zubieta², Paul Fortin³, Anne-Claude Gingras⁴, Maggie Larche⁵, Dawn Bowdish⁵, Claudie Berger⁶, Ines Colmegna⁷, Carol Hitchon⁸, Diane Lacaille², Dawn Richards⁹, Nadine Lalonde¹⁰, Ayesha Kirmani¹, Jennifer Lee¹¹ and Sasha Bernatsky⁶, ¹Arthritis Research Canada, Vancouver, BC, Canada, ²Arthritis Research Canada, University of British Columbia, Vancouver, BC, Canada, ³Centre ARThrite - CHU de Québec - Université Laval, Quebec, QC, Canada, ⁴Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada, ⁵McMaster University, Hamilton, ON, Canada, ⁶Research Institute of the McGill University Health Centre, Montreal, QC, Canada, ⁷The Research Institute of the McGill University Health Centre, Montréal, QC, Canada, ⁸University of Manitoba, Winnipeg, MB, Canada, ⁹Canadian Arthritis Patients Alliance, Toronto, ON, Canada, ¹⁰COVID-19 Global Rheumatology Alliance, London, ON, Canada, ¹¹The Research Institute of the McGill University Health Centre, Montreal, QC, Canada

Meeting: ACR Convergence 2024

Keywords: COVID-19, immunology, Infection, risk factors

Session Information

Date: Monday, November 18, 2024

Title: Epidemiology & Public Health Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: People with immune-mediated inflammatory diseases (IMIDs) may be more vulnerable to severe COVID-19 outcomes. COVID-19 vaccination is a key element in mitigating this risk. Anti-SARS-CoV-2 antibodies (Ab), including anti-spike (S) and anti-receptor binding domain (RBD) Ab, are metrics of seroconversion following COVID-19 vaccination in the general population. We assessed if anti-S and anti-RBD antibodies were negatively correlated with COVID-19 infection in individuals with IMIDs.

Methods: SUCCEED, a prospective Canada-wide study, was conducted in two phases. First, between Feb 2021 – Jul 2023, adult IMID participants provided dried blood spot samples for anti-S and anti-RBD ELISA testing at intervals of 1, 3, 6, and 12 months following each COVID-19 vaccine dose. Second, between Sep 2022 – Aug 2023, consenting participants from 4 centres also provided monthly saliva samples for PCR detection of SARS-CoV-2. We studied subjects receiving at least their primary series (3+ doses) of a COVID-19 vaccine.

Multivariable general estimating equation (GEE) models (accounting for repeated measures) evaluated PCR SARS-CoV-2 detection in saliva, assessing the effects of anti-S or anti-RBD levels (in separate models) within the 6 months preceding a given saliva sample. We controlled for recent COVID-19 infection, sex, age, medications (conventional immunosuppressives, biologics, and prednisone), and time since last COVID vaccine.

Results: 366 participants contributed 1,266 saliva samples. Participants were 79.8% female and 85.5% White, with median age 56.7 (standard deviation: 13.8) years. Most participants were taking immunosuppressants (N=252, 68.9%). The majority (N=356, 97.3%) of participants displayed seroconversion at the first saliva sample, defined as ≥11.3 Binding Antibody Units (BAU)/ml for anti-S or ≥31 BAU/ml for anti-RBD.

In the GEE models of positive saliva PCR for SARS-CoV-2, a 1000 BAU/ml increase in anti-S was associated with an adjusted odds ratio (aOR) of 0.66 (95% confidence interval [CI] 0.45-0.97). Anti-RBD Ab levels had a similar effect (aOR 0.91, 95% CI 0.81-1.02).

Conclusion: In this large, multi-centre sample of COVID-19-vaccinated individuals with IMIDs, most of whom were immunosuppressed, we demonstrated that anti-S Ab levels were associated with lower odds of positive saliva PCR test for SARS-CoV-2, with a similar trend for anti-RBD Ab. This highlights clear benefits for vaccination against SARS-CoV-2 to prevent COVID-19 disease in individuals with IMIDs.

Table 1. Characteristics of individuals providing saliva samples for COVID_19 PCR testing, at the time of first saliva sample.

Table 2. Odds Ratios and Confidence Intervals for testing COVID_19 positive on PCR test, represented by univariate and multivariate GEE models.

Figure 1. Proportion (95% Confidence Interval) of Positive Saliva Sample by Time-Point for Saliva Sample.

Disclosures: J. Tan: None; J. Avina-Zubieta: None; P. Fortin: AstraZeneca, 2, 6, GlaxoSmithKlein(GSK), 2, 6, Moderna, 2; A. Gingras: None; M. Larche: None; D. Bowdish: AstraZeneca, 1, Federal Government, 6, Pfizer, 1; C. Berger: None; I. Colmegna: None; C. Hitchon: None; D. Lacaille: None; D. Richards: None; N. Lalonde: Merck/MSD, 12, Stocks; A. Kirmani: None; J. Lee: None; S. Bernatsky: None.

To cite this abstract in AMA style:

Tan J, Avina-Zubieta J, Fortin P, Gingras A, Larche M, Bowdish D, Berger C, Colmegna I, Hitchon C, Lacaille D, Richards D, Lalonde N, Kirmani A, Lee J, Bernatsky S. Anti-Spike Antibodies Protect Against COVID-19 Infection in Immune-Mediated Inflammatory Diseases: Findings from the SUCCEED Study [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/anti-spike-antibodies-protect-against-covid-19-infection-in-immune-mediated-inflammatory-diseases-findings-from-the-succeed-study/. Accessed .

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