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We read with great interest the report by Tampe et al regarding their patient with granulomatosis with polyangiitis on rituximab who developed a serological response to SARS-CoV-2 and attenuated viral spread only after B cell reconstitution.1 This is an important observation, which is logical and further supports the recommendations to time the SARS-CoV-2 vaccine towards the end of the rituximab cycle and, if possible, to delay rituximab until 2–4 weeks after the second SARS-CoV-2 vaccination.2 3 While we agree with the authors that waiting for B cell reconstitution might improve response to the SARS-CoV-2 vaccine, patients on rituximab can have prolonged B cell depletion (as seen in this case) lasting months or years4—making this strategy impractical for many patients. In addition, it appears that the SARS-CoV-2 vaccines induces both B and T cell responses,5 although this remains incompletely understood. Given the urgency of the pandemic, timing the vaccine with rituximab dosing intervals rather than B cell reconstitution is likely a better strategy for most patients. Booster vaccinations will also likely need to be evaluated in rituximab-treated and other immunocompromised patients, as such strategies may be helpful in overcoming inadequate vaccine responses.
Handling editor Josef S Smolen
Contributors MAF drafted the initial correspondences and KLW reviewed and revised it. Both authors substantially contributed to the conception or design of the work. Both authors revised it critically for important intellectual content. Both authors approve the final version published, and both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding MAF is funded by NIH/NCATS KL2TR002370, and the OHSU Wheels Up programme. KLW is funded by research grants from BMS and Pfizer.
Competing interests KLW receives consulting fees from: Pfizer, AbbVie, Union Chimique Belge (UCB), Eli Lilly & Company, Galapagos, GlaxoSmithKline (GSK), Roche, Gilead, BMS, Regeneron, Sanofi, AstraZeneca, Novartis.
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 Commissioned; internally peer reviewed.