Durabilité des réponses immunitaires protectrices déclenchées par la primo-infection au SarS-Cov-2 chez les patients atteints de polyarthrite rhumatoïde ou de spondyloarthrite - Impact des traitements immunosuppresseurs – COVIRIC

Rheumatoid arthritis (RA) and spondyloarthitis (SPA) are the two most common chronic inflammatory rheumatic diseases, with a prevalence of 0.5-1% for RA and about 0.35% for SPA. Many studies have described an increased risk of serious infectious diseases directly associated with increased morbidity and mortality among those patients. This increased risk (frequency and severity) results from the disease itself, especially if the rheumatism is not controlled with high disease activity, but also due to the immunosuppressive treatments used to treat these patients.
The risk of infection is higher for patients on biotherapy than for patients on Disease Modifying Anti-Rheumatic Drugs (DMARDs - mainly Methotrexate) and the combination of corticosteroid therapy with the biotherapies further increases this risk of infection. Lung and upper respiratory tract infections are the most common infections observed under biotherapy. The risk of infection may be different depending on the biotherapy being considered. To best protect these patients, a specific vaccination policy is applied to them, in particular with a pneumococcal and influenza vaccination recommended to limit the risk of infection. The vaccine response of these patients is also highly variable depending on the immunosuppressive drug considered, with Rituximab, methotrexate, and abatacept being the treatments that most interfere with the quality of the vaccine response. In this context, it is warranted to question the impact of these immunosuppressive treatments on the natural immune response in case of viral infection, in particular to SARS-Cov-2 in the current pandemic context.

Since December 2019, the first SARS-Cov-2 (Severe acute respiratory coronavirus 2 syndrome) infections have been described in Wuhan province in China. The first cases were declared in China then the virus spread throughout the world, the epidemic having been declared as a pandemic by the International Health Organization on March 11, 2020. In September 2020, 30835922 confirmed cases of SarS-Cov-2 infection across the world with 957.790 reported deaths.

To date, we have no data concerning the seroconversion of infected subjects, the protective or non-protective nature of the specific antibodies generated, and the duration of protection among patients under immunosuppressive treatments.

However, major questions are currently unanswered for patients on immunosuppressive treatments: Are they excreting the virus for longer periods of time? How long can this viral excretion be measured in the upper airways and in the stool? Do they develop a humoral and cellular immune response comparable to the general population?

COVIRIC project aims to study the impact of immunosuppressive therapies used for patients with chronic inflammatory rheumatic diseases on the viral load and humoral and cellular responses during viral infection with SarSCoV2, compared to members of their infected family cluster.

Accurate knowledge of the dynamics of the virus and the immune response induced will be essential for the development of strategies for antiviral treatment, vaccination protocols, and for the epidemiological control of Covis-19 in this specific population of patients under immunosuppressive treatments.