Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
Clin Immunol. 2022 Jan;234:108897. doi: 10.1016/j.clim.2021.108897. Epub 2021 Nov 27.
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.
利妥昔单抗（RTX）是治疗风湿性疾病患者的重要治疗选择，已被证明可降低对各种疫苗的免疫反应。我们想知道在接种 SARS-CoV-2 疫苗后，RTX 治疗患者的反应率是否降低，以及是否有特定的患者特征影响反应。我们招募了正在接受慢性 RTX 治疗并接受抗 SARS-CoV-2 疫苗接种的患者，并测量了接种后抗刺突 IgG 抗体水平。从接种前 RTX 输注到接种疫苗以及从接种疫苗到接种后 RTX 输注的中位数时间分别为 20.5 周和 7.2 周。仅有 36.5%的患者在接种疫苗后产生可测量的 SARS-CoV-2 刺突抗体 IgG 滴度。低丙种球蛋白血症（IgG 和/或 IgM），而不是接种疫苗的时间、B 细胞数量或同时使用免疫抑制药物，与血清阴性（p=0.004）相关。我们的结果强调了一个事实，即使在 B 细胞重建后，RTX 诱导的慢性低丙种球蛋白血症也显著损害了免疫系统对 SARS-CoV-2 疫苗接种的反应能力。
