Patients With Systemic Lupus Erythematosus and COVID-19 Show Serologic Response Despite Immunosuppressant Use

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Elderly woman sitting on the edge of her bed taking her medication with a glass of water.
Researchers assessed the presence of SARS-CoV-2 IgG antibodies in patients with SLE with or without previous COVID-19-related symptoms or confirmed infection with SARS-CoV-2.

The majority of patients with systemic lupus erythematosus (SLE) and confirmed COVID-19 infection produce and maintain a serologic response, despite immunosuppressant use, according to study results published in Lancet Rheumatology.

Patients with SLE may be at risk for COVID-19 because of the underlying immune conditions and immunosuppressant medications. In the current study, researchers sought to evaluate the presence of SARS-CoV-2 immunoglobulin G (IgG) antibodies in patients with SLE with or without prior COVID-19-associated symptoms or a real-time polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection.

Patients with SLE were recruited from 2 cohorts in New York City, namely, the Web-Based Assessment of Autoimmune, Immune-Mediated and Rheumatic Patients During the COVID-19 Pandemic (WARCOV) study and the New York University (NYU) Lupus Cohort (a prospective registry of outpatients at NYU Langone Health and NYC Health + Hospitals/Bellevue). Patients from both cohorts were tested for SARS-CoV-2 IgG antibodies between April and February 2020 using commercially available immunoassays.

A total of 329 patients with SLE — 146 from the WARCOV study and 183 from the NYU Lupus Cohort — were included in the current analysis. Overall, 94% (n=309) of the patients were women; 28% (n=91) of patients were of Hispanic ethnicity. In the combined cohort, 16% (n=51) of the participants had a positive SARS-CoV-2 IgG antibody test; the remaining 84% (278) tested negative for SARS-CoV-2 IgG antibodies. Among patients who tested positive for SARS-CoV-2 antibodies, 47% were of Hispanic ethnicity compared with 24% who tested negative for the SARS-CoV-2 antibodies (P =.0010).

A total of 29 participants with confirmed RT-PCR positivity underwent SARS-CoV-2 IgG antibody testing, among whom 10 were admitted to the hospital, 26 were receiving hydroxychloroquine, 10 were receiving glucocorticoids, and 18 were receiving immunosuppressant medications. Overall, 83% of the patients with confirmed RT-PCR infection tested positive for SARS-CoV-2 IgG antibodies, with the remaining 17% testing negative.

Of the 36 participants who were initially tested as SARS-CoV-2 IgG-positive, 88% maintained reactivity serially for up to 10 weeks, 83% for up to 20 weeks, and 80% for up to 30 weeks. Overall, 70% of patients with confirmed COVID-19 exhibited antibody positivity even after 30 weeks from onset of the infection.

Researchers concluded that “[T]hese findings provide reassurance about patients’ abilities to generate an appropriate antibody response after infection and their possible protection against re-infection with similar strains of SARS-CoV-2.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Saxena A, Guttmann A, Masson M, et al; NYU WARCOV Investigators. Evaluation of SARS-CoV-2 IgG antibody reactivity in patients with systemic lupus erythematosus: analysis of a multi-racial and multi-ethnic cohort. Lancet Rheumatol. Published online May 27, 2021. doi:10.1016/S2665-9913(21)00114-4