Impact of rituximab on humoral response to SARS-CoV-2 vaccination in previously vaccinated patients with autoimmune diseases.
Biological therapy
Rituximab
SARS-CoV-2
Vaccines
Journal
Clinical rheumatology
ISSN: 1434-9949
Titre abrégé: Clin Rheumatol
Pays: Germany
ID NLM: 8211469
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
15
02
2023
accepted:
12
05
2023
revised:
16
04
2023
medline:
10
8
2023
pubmed:
27
5
2023
entrez:
27
5
2023
Statut:
ppublish
Résumé
SARS-CoV-2 infection is more severe in patients undergoing rituximab (RTX) treatment. Humoral response to vaccination is severely impaired in patients already treated with RTX, but data on antibody persistence in patients initiating RTX are lacking. We evaluated the impact of RTX initiation on humoral response to SARS-CoV-2 vaccination in previously vaccinated patients with immune-mediated inflammatory diseases. We performed a retrospective, multicenter study evaluating the evolution of anti-spike antibodies and breakthrough infections after initiation of RTX in previously vaccinated patients with protective levels of anti-SARS-CoV-2 antibodies. Threshold for anti-S antibodies positivity and protection were 30 and 264 BAU/mL, respectively. We included 31 previously vaccinated patients initiating RTX (21 female, median age 57 years). At first RTX infusion, 12 (39%) patients had received 2 doses of vaccine, 15 (48%) had received 3 doses, and 4 (13%) had received 4 doses. The most frequent underlying diseases were ANCA-associated vasculitis (29%) and rheumatoid arthritis (23%). Median anti-S antibody titers at RTX initiation, 3 months, and 6 months were 1620 (589-2080), 1055 (467-2080), and 407 (186-659) BAU/mL, respectively. Overall, antibody titers waned by almost two-fold at 3 months and four-fold at 6 months. Median antibody titers were significantly higher in patients who received ≥3 doses compared to those who received only 2 doses. Three patients developed SARS-CoV-2 infection without any severe symptom. Anti-SARS-CoV-2 antibody titers in previously vaccinated patients decline after RTX initiation similarly to general population. Specific monitoring is useful to anticipate prophylactic strategies. Key Points • Anti-SARS-CoV-2 antibody titers in previously vaccinated patients decline after rituximab initiation similarly to the general population. • The number of dose of vaccine before rituximab initiation is associated with higher antibody titers at month 3. • Monitoring antibody levels is mandatory to initiate prophylactic strategies in this population.
Identifiants
pubmed: 37243801
doi: 10.1007/s10067-023-06638-0
pii: 10.1007/s10067-023-06638-0
pmc: PMC10224652
doi:
Substances chimiques
Rituximab
4F4X42SYQ6
COVID-19 Vaccines
0
Antibodies, Viral
0
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2485-2490Informations de copyright
© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).
Références
Avouac J, Drumez E, Hachulla E et al (2021) COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study. Lancet Rheumatol 3:e419–e426. https://doi.org/10.1016/S2665-9913(21)00059-X
doi: 10.1016/S2665-9913(21)00059-X
pubmed: 33786454
pmcid: 7993930
FAI2R /SFR/SNFMI/SOFREMIP/CRI/IMIDIATE consortium and contributors (2021) Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients. Ann Rheum Dis 80:527–538. https://doi.org/10.1136/annrheumdis-2020-218310
doi: 10.1136/annrheumdis-2020-218310
Strangfeld A, Schäfer M, Gianfrancesco MA et al (2021) Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 80:930–942. https://doi.org/10.1136/annrheumdis-2020-219498
doi: 10.1136/annrheumdis-2020-219498
pubmed: 33504483
Feng S, Phillips DJ, White T et al (2021) Correlates of protection against symptomatic and asymptomatic SARS-CoV-2 infection. Nat Med 27:2032–2040. https://doi.org/10.1038/s41591-021-01540-1
doi: 10.1038/s41591-021-01540-1
pubmed: 34588689
pmcid: 8604724
Prendecki M, Clarke C, Edwards H et al (2021) Humoral and T-cell responses to SARS-CoV-2 vaccination in patients receiving immunosuppression. Ann Rheum Dis 80:1322–1329. https://doi.org/10.1136/annrheumdis-2021-220626
doi: 10.1136/annrheumdis-2021-220626
pubmed: 34362747
Mrak D, Tobudic S, Koblischke M et al (2021) SARS-CoV-2 vaccination in rituximab-treated patients: B cells promote humoral immune responses in the presence of T-cell-mediated immunity. Ann Rheum Dis 80:1345–1350. https://doi.org/10.1136/annrheumdis-2021-220781
doi: 10.1136/annrheumdis-2021-220781
pubmed: 34285048
Jyssum I, Kared H, Tran TT et al (2022) Humoral and cellular immune responses to two and three doses of SARS-CoV-2 vaccines in rituximab-treated patients with rheumatoid arthritis: a prospective, cohort study. Lancet Rheumatol 4:e177–e187. https://doi.org/10.1016/S2665-9913(21)00394-5
doi: 10.1016/S2665-9913(21)00394-5
pubmed: 34977602
Mrak D, Simader E, Sieghart D et al (2022) Immunogenicity and safety of a fourth COVID-19 vaccination in rituximab-treated patients: an open-label extension study. Ann Rheum Dis 81(12):1750–1756. https://doi.org/10.1136/ard-2022-222579
doi: 10.1136/ard-2022-222579
pubmed: 35977809
Hadjadj J, Planas D, Ouedrani A et al (2022) Immunogenicity of BNT162b2 vaccine against the alpha and delta variants in immunocompromised patients with systemic inflammatory diseases. Ann Rheum Dis 81:720–728. https://doi.org/10.1136/annrheumdis-2021-221508
doi: 10.1136/annrheumdis-2021-221508
pubmed: 35022159
Conseil d’Orientation de la Stratégie Vaccinale Recommandations pour la protection des personnes sévèrement immunodéprimées contre le Covid-19 (Vaccination et prophylaxie primaire) – 19 Novembre 2021. Available at : https://sante.gouv.fr/grands-dossiers/vaccin-covid-19/covid-19-la-strategie-vaccinale/article/les-avis-du-conseil-dorientation-de-la-strategie-vaccinale . Accessed 17 Mar 2023
Wei J, Pouwels KB, Stoesser N et al (2022) Antibody responses and correlates of protection in the general population after two doses of the ChAdOx1 or BNT162b2 vaccines. Nat Med 28:1072–1082. https://doi.org/10.1038/s41591-022-01721-6
doi: 10.1038/s41591-022-01721-6
pubmed: 35165453
pmcid: 9117148
Zhang Z, Mateus J, Coelho CH et al (2022) Humoral and cellular immune memory to four COVID-19 vaccines. Cell 185(14):2434–243s. https://doi.org/10.1016/j.cell.2022.05.022
doi: 10.1016/j.cell.2022.05.022
pubmed: 35764089
pmcid: 9135677
Bertrand D, Laurent C, Lemée V et al (2022) Efficacy of anti–SARS-CoV-2 monoclonal antibody prophylaxis and vaccination on the omicron variant of COVID-19 in kidney transplant recipients. Kidney Int 102:440–442. https://doi.org/10.1016/j.kint.2022.05.007
doi: 10.1016/j.kint.2022.05.007
pubmed: 35618097
pmcid: 9125992
Jeulin H, Labat C, Duarte K et al (2022) Anti-spike IGG antibody kinetics following the second and third doses of BNT162B2 vaccine in nursing home residents. J Am Geriatr Soc 70(9):2552–2560. https://doi.org/10.1111/jgs.17837
doi: 10.1111/jgs.17837
pubmed: 35484977