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Triebelhorn, J.* ; Schneider, J.* ; Spinner, C.D.* ; Iakoubov, R.* ; Voit, F.* ; Wagner, L.* ; Erber, J.* ; Rothe, K.* ; Berthele, A.* ; Pernpeintner, V.* ; Strauß, E.M.* ; Renders, L.* ; Willmann, A. ; Minic, M. ; Vogel, E. ; Christa, C. ; Hoffmann, D. ; Protzer, U. ; Jeske, S.

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.

Infection, DOI: 10.1007/s15010-023-02171-z (2024)
Publ. Version/Full Text DOI PMC
Open Access Gold (Paid Option)
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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.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords B-cell Depletion ; Covid-19 ; Immunosuppression ; Monoclonal Antibodies ; Sars-cov-2 ; Nmabs
ISSN (print) / ISBN 0300-8126
e-ISSN 1439-0973
Journal Infection - A Journal of Infectious Disease
Publisher Urban & Vogel
Publishing Place Tiergartenstrasse 17, D-69121 Heidelberg, Germany
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Virology (VIRO)
Grants Technische Universitt Mnchen (1025)