A beacon in the dark: COVID-19 course in CVID patients from two European countries: Different approaches, similar outcomes

Abstract

BackgroundCVID patients present an increased risk of prolonged SARS-CoV-2 infection and re-infection and a higher COVID-19-related morbidity and mortality compared to the general population. Since 2021, different therapeutic and prophylactic strategies have been employed in vulnerable groups (vaccination, SARS-CoV-2 monoclonal antibodies and antivirals). The impact of treatments over the last 2 years has not been explored in international studies considering the emergence of viral variants and different management between countries.MethodsA multicenter retrospective/prospective real-life study comparing the prevalence and outcomes of SARS-CoV-2 infection between a CVID cohort from four Italian Centers (IT-C) and one cohort from the Netherlands (NL-C), recruiting 773 patients.Results329 of 773 CVID patients were found positive for SARS-CoV-2 infection between March 1st, 2020 and September 1st 2022. The proportion of CVID patients infected was comparable in both national sub-cohorts. During all waves, chronic lung disease, “complicated” phenotype, chronic immunosuppressive treatment and cardiovascular comorbidities impacted on hospitalization, whereas risk factors for mortality were older age, chronic lung disease, and bacterial superinfections. IT-C patients were significantly more often treated, both with antivirals and mAbs, than NL-C patients. Outpatient treatment, available only in Italy, started from the Delta wave. Despite this, no significant difference was found for COVID-19 severity between the two cohorts. However, pooling together specific SARS-CoV-2 outpatient treatments (mAbs and antivirals), we found a significant effect on the risk of hospitalization starting from Delta wave. Vaccination with ≥ 3 doses shortened RT-PCR positivity, with an additional effect only in patients receiving antivirals.ConclusionsThe two sub-cohorts had similar COVID-19 outcomes despite different treatment approaches. This points out that specific treatment should now be reserved for selected subgroups of CVID patients, based on pre-existing conditions.

High Prevalence of Long COVID in Common Variable Immunodeficiency: An Italian Multicentric Study

“…In patients with IEIs, there is an increased risk of severe and fatal COVID-19 disease when compared to the general population [ 22 – 24 ]. More specifically, CVID patients have specific risk factors that expose them to a severe and prolonged course of SARS-CoV-2 infection and a high rate of reinfection [ 26 , 27 ]. Chronic lung disease, a complicated clinical phenotype, and chronic immunosuppressive treatment were found to be associated with an increased risk of COVID-19-related hospitalization and death [ 22 , 26 , 27 ].…”

“…More specifically, CVID patients have specific risk factors that expose them to a severe and prolonged course of SARS-CoV-2 infection and a high rate of reinfection [ 26 , 27 ]. Chronic lung disease, a complicated clinical phenotype, and chronic immunosuppressive treatment were found to be associated with an increased risk of COVID-19-related hospitalization and death [ 22 , 26 , 27 ]. The CVID cohort analyzed in the present study reflects the epidemiology of CVID cohorts described in literature, presenting a younger median age than the general population and an increased incidence of respiratory involvement, autoimmune complications, and malignancy [ 35 ].…”

“…In our cohort, hospitalization during infection tends to have an impact on LC development, even if not reaching statistical significance. In a previous study, we demonstrated that complicated phenotype is a risk factor for hospitalization in CVID patients during SARS-CoV-2 infection [ 26 ]. In the present study, LC correlates with complicated phenotype in CVID patients.…”

“…Despite the higher susceptibility to infections, studies focusing on their post-acute sequelae in CVID are lacking. Besides a higher risk of hospitalization and death during SARS-CoV-2 infection, these patients experienced prolonged course of COVID-19 and a higher rate of reinfection [ 26 , 27 ].…”

SARS-CoV-2 vaccination in primary antibody deficiencies: an overview on efficacy, immunogenicity, durability of immune response and safety

“…In CVID and IEI patients, the response to the first course of three vaccine doses (mostly done with mRNA vaccines), the availability of specific antiviral treatments and the current prevailing omicron lineage subvariants have led to an attenuated severity even in the context of preexistent severe comorbidities [38,39].…”