JCI Insight (Apr 2023)

Short- and long-term T cell and antibody responses following dexamethasone treatment in COVID-19

  • Charlotte Thibeault,
  • Lara Bardtke,
  • Kanika Vanshylla,
  • Veronica di Cristanziano,
  • Kirsten A. Eberhardt,
  • Paula Stubbemann,
  • David Hillus,
  • Pinkus Tober-Lau,
  • Parnika Mukherjee,
  • Friederike Münn,
  • Lena J. Lippert,
  • Elisa T. Helbig,
  • Tilman Lingscheid,
  • Fridolin Steinbeis,
  • Mirja Mittermaier,
  • Martin Witzenrath,
  • Thomas Zoller,
  • Pa-COVID study group,
  • Florian Klein,
  • Leif E. Sander,
  • Florian Kurth

Journal volume & issue
Vol. 8, no. 8

Abstract

Read online

BACKGROUND After its introduction as standard-of-care for severe COVID-19, dexamethasone has been administered to a large number of patients globally. Detailed knowledge of its impact on the cellular and humoral immune response to SARS-CoV-2 remains scarce.METHODS We included immunocompetent individuals with (a) mild COVID-19, (b) severe COVID-19 before introduction of dexamethasone treatment, and (c) severe COVID-19 infection treated with dexamethasone from prospective observational cohort studies at Charité-Universitätsmedizin Berlin, Germany. We analyzed SARS-CoV-2 spike–reactive T cells, spike-specific IgG titers, and serum neutralizing activity against B.1.1.7 and B.1.617.2 in samples ranging from 2 weeks to 6 months after infection. We also analyzed BA.2 neutralization in sera after booster immunization.RESULTS Patients with severe COVID-19 and dexamethasone treatment had lower T cell and antibody responses to SARS-CoV-2 compared with patients without dexamethasone treatment in the early phase of disease, which converged in both groups before 6 months after infection and also after immunization. Patients with mild COVID-19 had comparatively lower T cell and antibody responses than patients with severe disease, including a lower response to booster immunization during convalescence.CONCLUSION Dexamethasone treatment was associated with a short-term reduction in T cell and antibody responses in severe COVID-19 when compared with the nontreated group, but this difference evened out 6 months after infection. We confirm higher cellular and humoral immune responses in patients after severe versus mild COVID-19 and the concept of improved hybrid immunity upon immunization.FUNDING Berlin Institute of Health, German Federal Ministry of Education, and German Federal Institute for Drugs and Medical Devices.

Keywords