Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Division of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
Clin Immunol. 2022 Dec;245:109144. doi: 10.1016/j.clim.2022.109144. Epub 2022 Oct 8.
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.
利妥昔单抗（RTX）是治疗自身免疫性风湿病（AIRD）的非常有效的药物，但它会增加感染风险并损害疫苗反应。在此，我们评估了 RTX 治疗患者对补充 COVID-19 疫苗的抗体反应。在补充剂量后，53.1%的患者有可检测到的抗体滴度。仅在原始疫苗系列后未产生抗体反应的患者中，有 36%在补充剂量后（血清转化率）有可检测到的抗体。CD20 细胞水平检测不到的患者未发生血清转化率，而低丙种球蛋白血症则使血清转化率降低了 15 倍。尽管我们在补充剂量后注意到 11 例 COVID-19 感染，但没有接受过单克隆抗体暴露前预防的患者随后发生 COVID-19。我们建议，应继续优先为接受 RTX 治疗的患者采取预防措施，并且应尽可能在 B 细胞恢复后安排疫苗接种。
