B‐Cell Depletion Relative to Tumor Necrosis Factor Inhibition Extends the Duration of Viral Shedding in COVID‐19 Among Autoimmune Disease Patients: A Matched Prospective Cohort Study

Year: 2026

Type: article

Abstract: OBJECTIVE: To investigate SARS-CoV-2 viral shedding duration in autoimmune patients using B cell depleting (BCD) therapy or tumor necrosis factor inhibitors (TNFi) and immunocompetent comparators. METHODS: We conducted a matched cohort analysis among participants in POSITIVES, a prospective study enrolling outpatients with acute COVID-19 within five days of diagnosis. Anterior nasal swabs were self-collected thrice weekly over two weeks and then weekly until two negative polymerase chain reaction (PCR) results. We compared autoimmune cases on BCD or TNFi at baseline with immunocompetent comparators, matched using a propensity score based on age, sex, race and ethnicity, number of COVID-19 vaccinations, calendar time, and antiviral use. Survival methods with Cox proportional hazards modeling was used to compare the time to undetectable PCR. RESULTS: We enrolled 16 BCD users and 30 TNFi users, each matched to 33 and 53 immunocompetent comparators, respectively. The most common autoimmune disease was rheumatoid arthritis (31% among BCD and 53% among TNFi). About 60% used an antiviral, and the mean number of COVID-19 vaccinations was 4.3. At the time of infection, BCD users had significantly longer viral shedding duration than comparators (median 15 vs 7 days; hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.22-0.86; P = 0.017). The median time to undetectable viral load was similar between TNFi users and comparators (10 vs 8 days; HR 0.77, 95% CI 0.48-1.23; P = 0.27). CONCLUSION: BCD users had eight days longer viral shedding duration than immunocompetent comparators; TNFi users and comparators had similar viral shedding duration. These findings inform clinical and public health strategies for autoimmune patients with COVID-19.

Source: ACR Open Rheumatology

DOI: 10.1002/acr2.90120

Institutions: Brigham and Women's Hospital, Harvard University, Massachusetts General Hospital, University of Pittsburgh, Ragon Institute of MGH, MIT and Harvard, Mass General Brigham, Massachusetts Institute of Technology

Language: English

Topic: COVID-19 Clinical Research Studies

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,550

Funders: Massachusetts Consortium on Pathogen Readiness, National Institutes of Health, National Institute of Allergy and Infectious Diseases

Awards: Advancing genomic, transcriptomic and functional approaches to combat globally important and emerging pathogens, Characterization of Persistent COVID-19, Harvard University Center for AIDS Research

OpenAlex ID: W7202259897