Seroconversion among rituximab-treated patients following SARS-CoV-2 vaccine supplemental dose

Rituximab (RTX) is a very effective treatment for autoimmune rheumatic diseases (AIRD), but it increases infection risk and impairs vaccine responses. Herein we evaluated the antibody response of RTX-treated patients to the supplemental COVID-19 vaccine. After the supplemental dose, 53.1% of patient...

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Bibliographic Details
Published in:Clinical immunology (Orlando, Fla.) Fla.), 2022-12, Vol.245, p.109144-109144, Article 109144
Main Authors: Rose, Emily, Magliulo, Daniel, Kyttaris, Vasileios C.
Format: Article
Language:English
Subjects:
Antibodies, Viral - therapeutic use
Autoimmune Diseases
B cells
COVID-19
COVID-19 - prevention & control
COVID-19 Drug Treatment
COVID-19 Vaccines
Humans
Hypogammaglobinemia
Rituximab
Rituximab - therapeutic use
SARS-CoV-2
Seroconversion
Vaccination
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Summary:Rituximab (RTX) is a very effective treatment for autoimmune rheumatic diseases (AIRD), but it increases infection risk and impairs vaccine responses. Herein we evaluated the antibody response of RTX-treated patients to the supplemental COVID-19 vaccine. After the supplemental dose, 53.1% of patients had detectable antibody titers. Only 36% of patients who did not mount an antibody response after the original vaccine series did have detectable antibodies after the supplemental dose (seroconversion). Patients with undetectable CD20+ cell levels did not seroconvert while hypogammaglobulinemia was associated with a 15-times decrease in the likelihood of seroconversion. Although we noted 11 COVID-19 infections after the supplemental dose, no patients who received monoclonal antibodies pre-exposure prophylaxis had COVID-19 afterwards. We propose that patients receiving RTX should continue to be prioritized for prophylaxis measures and that vaccination should be timed after B cell recovery wherever possible. [Display omitted] •A little more than half of Rituximab-treated patients mounted an antibody response after SARS-CoV-2 supplemental dose•Patients with hypogammaglobulinemia were significantly less likely than controls to respond to the COVID19 vaccine.•Patients with undetectable CD20+ cells did not develop an antibody response to the supplemental vaccine•Pre-exposure prophylaxis is very efficacious in preventing infections.
ISSN:1521-6616
1521-7035
DOI:10.1016/j.clim.2022.109144