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. 2022 Jan:234:108897.
doi: 10.1016/j.clim.2021.108897. Epub 2021 Nov 27.

Immunogenicity of SARS-CoV-2 vaccination in rituximab-treated patients: Effect of timing and immunologic parameters

Daniel Magliulo  1 , Stefanie D Wade  1 , Vasileios C Kyttaris  2
Affiliations

Immunogenicity of SARS-CoV-2 vaccination in rituximab-treated patients: Effect of timing and immunologic parameters

Daniel Magliulo et al. Clin Immunol. 2022 Jan.

Abstract

Rituximab (RTX), an important therapeutic option for patients with rheumatic diseases, has been shown to reduce immune responses to various vaccines. We asked whether following SARS-CoV-2 vaccination, response rates in RTX treated patients are reduced and whether specific patient characteristics influence the responses. We recruited patients on chronic RTX therapy undergoing anti-SARS-CoV2 vaccination and measured the post-vaccination anti-spike IgG antibody levels. The median time from pre-vaccination RTX infusion to vaccination and from vaccination to the post-vaccination RTX infusion was 20.5 weeks and 7.2 weeks respectively. Only 36.5% of patients developed measurable titers of IgG anti-SARS-CoV-2 spike antibody after vaccination. Hypogammaglobulinemia (IgG and/or IgM) but not timing of vaccination, B cell numbers, or concomitant immune suppressive medications, correlated with sero-negativity (p = 0.004). Our results underscore the fact that even after B cell reconstitution, RTX induced chronic hypogammaglobulinemia significantly impairs the ability of the immune system to respond to SARS-CoV-2 vaccination.

Keywords: Autoimmune diseases; B cells; COVID-19; Rituximab; Vaccination.

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Figures

Fig. 1
Fig. 1
Flowchart of study enrollment and data collection. Patients with AIRD treated with RTX were included in the study. Patients who had RTX stopped or postponed indefinitely during study period were excluded. One patient declined participation in the study. Seventy-two patients were included for chart review and telephone survey. Sixty-three patients completed a full vaccine series and anti-spike antibody data was available for 41 of those patients.
Fig. 2
Fig. 2
Multivariate logistic regression analysis of select factors correlated to post-immunization seropositivity. The odds ratios (OR) and confidence intervals for hypogammaglobulinemia, age, corticosteroid use, conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) are shown.
See this image and copyright information in PMC

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