Rituximab decreases antibody response to COVID vaccination

Arthritis & RheumatismStefanski AL, Rincon-Arevalo H, Schrezenmeier E, et al. | January 25, 2022

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i>NOTE, original article title: B cell numbers predict humoral and cellular response upon SARS-CoV-2 vaccination among patients treated with rituximab

Risk for poor COVID-19 outcomes is higher and humoral anti-SARS-CoV-2 vaccine responses are substantially impaired in patients with autoimmune inflammatory rheumatic diseases receiving rituximab (RTX) therapy. Researchers herein aimed at assessing the complex relationship between antigen-specific B and T cells and the level of B cell repopulation necessary to achieve anti-vaccine responses.

  • Nineteen rheumatoid arthritis (RA) and ANCA-associated vasculitis (AAV) patients receiving RTX, 12 RA patients on other therapies and 30 healthy controls were examined after SARS-CoV-2 vaccination with either mRNA or vector based vaccines for their antibody responses to SARS-CoV-2 vaccines and induction of antigen-specific B and CD4/CD8 T cell subsets.

  • In RTX patients, there appeared a necessity for a minimum of 10 B cells/μL (0,4% of lymphocytes) in the peripheral circulation to mount seroconversion to anti-S1 IgG upon SARS-CoV-2 vaccination.

  • RBD+ B cells were reduced, frequency of TfH-like cells was lower and activated CD4 and CD8 T cells were less in RTX patients lacking IgG seroconversion when compared with IgG seroconverted RTX patients.

  • Overall findings support the relevance of a minimum of 10 B cells/μl in the peripheral circulation as biomarker for a high likelihood of an appropriate cellular and humoral response after SARS-CoV-2 vaccination.

  • Mechanistically, the data indicate that co-stimulatory B cell functions have a crucial role for the proper induction of CD4 responses propagating vaccine-specific B and plasma cell differentiation.

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