key: cord-0885633-bfo73pzk
authors: Kant, Sam; Geetha, Duvuru
title: Impact of rituximab on humoral response to COVID-19 booster vaccine and antibody kinetics in patients with ANCA vasculitis
date: 2021-09-07
journal: Kidney Int
DOI: 10.1016/j.kint.2021.08.020
sha: 17bb05bbf6524aae47ea658757ecfd7ff9124b78
doc_id: 885633
cord_uid: bfo73pzk

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The advent of vaccines has resulted in mitigation of severe disease as a consequence of SARS-CoV-2.

There is notable absence of humoral absence after two doses of mRNA vaccines in rheumatic and musculoskeletal diseases. 1 There has been evidence that administration of third dose of vaccine leads to augmentation of humoral response in kidney transplant recipients. 2 In addition, there is increasing evidence that neutralizing antibody titers correlate with reduction in breakthrough infections in vaccinated individuals. 3 To further understand these aspects in patients with with anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) on immunosuppression, we elucidated antibody response to booster doses of the COVID-19 vaccine; and sought to ascertain the effect of rituximab on SARS-CoV-2 antibody titers, given immunosuppression is known to alter immunogenicity of vaccine.

AAV patients attending the vasculitis clinic at Johns Hopkins on rituximab therapy were screened for a completion of vaccine series and associated antibody response between April 2021 and June 2021.

Immunoglobulin G antibodies to spike protein S1 subunit of on SARS-CoV-2 were measured using ELISA (Clinical Immunology Laboratory of the Johns Hopkins Hospital) at least 1 month post completion of vaccination series and then after 1 month post rituximab administration. Clinical demographics and immunological data were retrieved after review of the electronic health record. Four patients with demonstrable antibody levels due to receive rituximab therapy were included. In addition, we identified a separate cohort of patients who lacked humoral response to the initial vaccine administration and received a booster dose. Antibody responses to spike protein of severe acute respiratory syndrome antibodies. 4 It has been previously suggested that a delay in vaccine administration for at least 6 months post rituximab administration or B cell reconstitution should be considered to maximize efficacy of vaccines. 5 Another pertinent aspect that warrants discussion is the the immunogenicity of viral vector based COVID-19 vaccines. In accordance with our series, the antibody response post viral vector COVID-19 vaccines may be suboptimal for immunocompromised patients as has been demonstrated in a previous study. 4 This finding does require more robust investigation to clarify which type of COVID-19 vaccine yields the most efficacious immune response.

While the focus of the medical community is to enhance the immunogenicity of the vaccines to aid in protection of this vulnerable population, the effect of immunosuppression on patients with established generation of SARS-CoV-2 antibodies in unknown. In addition, rituximab has been known to be associated with reduced humoral response to pneumococcal and influenza vaccines. 6 

Absence of humoral response after two-dose SARS-CoV-2

messenger RNA vaccination in patients with rheumatic and musculoskeletal diseases: A case series

Antibody response after a third dose of the mRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients with minimal serologic response to 2 doses

Covid-19 breakthrough infections in vaccinated health care workers. The New England journal of medicine

SARS-CoV-2 vaccination in rituximabtreated patients: Evidence for impaired humoral but inducible cellular immune response" by bonelli et al. Annals of the rheumatic diseases

Timing of COVID-19 vaccine in the setting of anti-CD20 therapy: A primer for nephrologists

Immunization responses in rheumatoid arthritis patients treated with rituximab: Results from a controlled clinical trial