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  • Correspondence on “SARS-CoV-2 vaccination in rituximab-treated patients: evidence for impaired humoral but inducible cellular immune response” by Bonelli et al

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Correspondence
Correspondence on “SARS-CoV-2 vaccination in rituximab-treated patients: evidence for impaired humoral but inducible cellular immune response” by Bonelli et al
  1. Caoilfhionn Marie Connolly1,
  2. Darya Koenig2,
  3. Srekar N Ravi3,
  4. Antoine Azar2,
  5. Sam Kant4,
  6. Monika Dalal1,
  7. Jessica Duchen5,
  8. Philip Seo1,
  9. Brendan Antiochos1,
  10. Julie J Paik1,
  11. Duvuru Geetha1,4
  1. 1 Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Division of Allergy and Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3 Department of Medicine, Florida Atlantic University—Treasure Coast Campus, Boca Raton, Florida, USA
  4. 4 Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  5. 5 Biostatistics, Epidemiology and Data Management, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Duvuru Geetha, MEDICINE, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; gduvura{at}jhmi.edu

https://doi.org/10.1136/annrheumdis-2021-220972

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    SARS-CoV-2 vaccination elicited high levels of immunogenicity in immunocompetent people in the original vaccine trials1 2 though recent studies have shown blunted immunogenicity in patients with rheumatic diseases treated with lymphocyte depleting agents.3 4 B-lymphocytes have been implicated in the pathogenesis of anti-neutrophil cytoplasmic antibidy (ANCA)-associated vasculitis (AAV) and B-cell-targeted therapy with rituximab is recognised as an established induction and maintenance strategy in management.5 6 SARS-CoV-2 infection in patients with AAV has been associated with severe outcomes,7 while rituximab has been associated with worse outcomes among patients infected with SARS-CoV-2.8 9 A recent study by Bonelli et al found evidence of an ameliorated humoral response but possible inducible cellular response in five patients treated with rituximab.10

    We studied the tolerability and humoral response to the SARS-CoV-2 vaccine series in 48 patients with a diagnosis of AAV. Patients underwent SARS-CoV-2 antispike antibody testing to assess humoral response. Antibody testing was performed using antispike IgG enzyme immunoassay (Roche Elecsys via Quest, DiaSorin Liaison assay via LabCorp or Euroimmun via Hopkins lab). Demographics, clinical information including immunosuppressive therapy were extracted from medical records. Time from last rituximab administration to receipt of the first dose of the vaccine was recorded. We recorded serum creatinine, white blood cell count, serum immunoglobulins, Cluster of CD19 and …

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    Footnotes

    • Twitter @CaoilfhionnMD

    • Contributors All authors contributed equally to this manuscript.

    • Funding This work was supported by grant number K23AR073927 (Paik) from National Institute of Arthritis and Musculoskeletal and Skin Diseases. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government.

    • Competing interests DG has the following disclosures: consultant to ChemoCentryx and Aurinia.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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