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Rituximab, but not other antirheumatic therapies, is associated with impaired serological response to SARS- CoV-2 vaccination in patients with rheumatic diseases
  1. Robert Spiera1,2,
  2. Sarah Jinich1,
  3. Deanna Jannat-Khah1,2
  1. 1 Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA
  2. 2 Department of Medicine, Division of Rheumatology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Robert Spiera, Department of Medicine, Hospital for Special Surgery, New York, NY 10028, USA; spierar{at}

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There is a paucity of data on the effect of antirheumatic drugs on serological responses to COVID-19 vaccines. Anti-CD20 therapies deplete B-cells, with reconstitution often not beginning for 6–9 months after infusion, resulting in diminished humoral immune responsiveness to recall antigens.1–6 We retrospectively assessed response to COVID-19 vaccination in rheumatic disease patients treated with a variety of antirheumatic medications including rituximab.

A retrospective chart review of adult patients from one rheumatology practice who received at least one dose of a COVID-19 vaccine was performed. Data were collected from patients who had a clinic visit from 24 February 2021 to 8 April 2021 and were serologically screened for antibodies to the SARS-CoV-2 Spike protein.

Serological response to vaccination was assessed using a semiquantitative anti-SARS-CoV-2 enzyme immunoassay.

Vaccination responsiveness was compared between patients receiving various antirheumatic medications. In patients treated with rituximab time between most recent administration of drug and vaccination was recorded. Exposure to rituximab was defined as having ever been treated, however, all patients were within 4.5 years (median (IQR) 0.70 (0.41–1.74)) years of last exposure. B-cell reconstitution at time of anti-SARS-CoV-2 antibodies measurement was documented, when available, for rituximab-treated patients.

Primary outcome was the presence of a serological response to COVID-19 vaccination. Descriptive statistics, box …

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  • Handling editor Josef S Smolen

  • Contributors Study design: RS. Data collection: SJ and RS. Data analysis: RS and DJ-K. Writing of manuscript: all authors. Proof reading of manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RS has received research funding from GlaxoSmithKline, Genentech /Roche, Novartis, Corbus Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, InflaRx, Sanofi, Formation Biologics, Pharmaceuticals, and Kadmon, and has consulted for Formation Biologics, Glaxosmthkline, Janssen Pharmaceuticals, Sanofi Aventis, Chemocentryx, Abbvie and Regeneron. DJ-K owns stock in Cytodyn, GW pharmaceuticals, Astrazeneca and Walgreens.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.