Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 5;62(7):2544-2549.
doi: 10.1093/rheumatology/keac666.

Rituximab-treated rheumatic patients: B cells predict seroconversion after COVID-19 boost or revaccination in initial vaccine non-responders

Christian Ammitzbøll  1   2 , Marianne Kragh Thomsen  2   3 , Jakob Bøgh Andersen  1 , Jens Magnus Berth Jensen  4   5 , Marie-Louise From Hermansen  1 , Anders Dahl Johannsen  1 , Mads Lamm Larsen  1 , Clara Elbæk Mistegaard  1   2   6 , Susan Mikkelsen  4 , Fruzsina Szabados  7 , Signe Risbøl Vils  1   6 , Christian Erikstrup  2   4 , Ellen-Margrethe Hauge  1   2 , Anne Troldborg  1   6
Affiliations

Rituximab-treated rheumatic patients: B cells predict seroconversion after COVID-19 boost or revaccination in initial vaccine non-responders

Christian Ammitzbøll et al. Rheumatology (Oxford). .

Abstract

Objectives: To investigate the effect of either a booster vaccine (one dose) or revaccination (two doses 3 weeks apart) on the antibody response to the COVID-19 mRNA vaccines in patients with rheumatic disease (RD) treated with rituximab (RTX) who had not produced vaccine-reactive antibodies after the initial two vaccine doses. Further, to examine if B cell levels in peripheral blood predicted seroconversion.

Methods: We included 91 RTX-treated RD patients previously vaccinated against COVID-19. Patients were offered revaccination or a single booster vaccination with an mRNA vaccine. Serum total antibodies against SARS-CoV-2 spike protein were measured before and 6 weeks after the last vaccine dose. B cells (CD19+CD45+) were measured by flow cytometry at inclusion.

Results: Of RD patients with undetectable SARS-CoV-2 antibody levels before inclusion, seroconversion was seen in 38% 6 weeks after the booster dose and 32% after revaccination. Patients receiving revaccination had significantly higher antibody levels than patients receiving a booster dose (P < 0.001). In both univariate and multivariate logistic regression analysis, only B cells higher than 10/µl before boost or revaccination were associated with seroconversion (P = 0.009 and P = 0.01, respectively). Seroconversion was independent of age, gender, diagnosis, cumulative RTX dose, RTX treatment time and time since last RTX treatment.

Conclusion: Continuously impaired humoral response to mRNA vaccines was found in most RTX-treated patients after a booster dose or revaccination. Seroconversion was observed in approximately one-third of the patients. Measurable B cells before boosting or revaccination was the strongest predictor of antibody response after boost or revaccination.

Keywords: B cell depleting therapy; COVID-19; autoimmune disease; mRNA vaccine; pandemic; rheumatic diseases; rituximab; vaccine; vaccine recommendation; vaccine response.

PubMed Disclaimer

Publication types