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Rituximab-treated rheumatic patients: B-cells predict seroconversion after COVID-19 boost or revaccination in initial vaccine non-responders.
Ammitzbøll, Christian; Kragh Thomsen, Marianne; Bøgh Andersen, Jakob; Jensen, Jens Magnus Berth; From Hermansen, Marie-Louise; Dahl Johannsen, Anders; Larsen, Mads Lamm; Mistegaard, Clara Elbæk; Mikkelsen, Susan; Szabados, Fruzsina; Vils, Signe Risbøl; Erikstrup, Christian; Hauge, Ellen-Margrethe; Troldborg, Anne.
  • Ammitzbøll C; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
  • Kragh Thomsen M; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Bøgh Andersen J; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Jensen JMB; Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
  • From Hermansen ML; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
  • Dahl Johannsen A; Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
  • Larsen ML; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
  • Mistegaard CE; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
  • Mikkelsen S; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
  • Szabados F; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
  • Vils SR; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
  • Erikstrup C; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Hauge EM; Department of Biomedicine, Aarhus University, Aarhus, Denmark.
  • Troldborg A; Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
Rheumatology (Oxford) ; 2022 Nov 29.
Article in English | MEDLINE | ID: covidwho-2135575
ABSTRACT

OBJECTIVES:

To investigate the effect of either a booster vaccine (one dose) or revaccination (two doses three weeks apart) on the antibody response to the COVID-19 mRNA vaccines in patients with rheumatic disease (RD) treated with Rituximab (RTX), who had not produced vaccine-reactive antibodies after the initial two vaccine doses. Further, to examine if B cell levels in peripheral blood predicted seroconversion.

METHODS:

We included 91 RTX-treated RD patients previously vaccinated against COVID-19. Patients were offered revaccination or a single booster vaccination with an mRNA vaccine. Serum total antibodies against SARS-CoV-2 spike protein were measured before and six weeks after the last vaccine dose. B-cells (CD19+CD45+) were measured by flow cytometry at inclusion.

RESULTS:

Of RD patients with undetectable SARS-CoV-2 antibody levels before inclusion, seroconversion was seen in 38% six weeks after the booster dose and 32% after revaccination. Patients receiving revaccination had significantly higher antibody levels than patients receiving a booster dose (p< 0.001). In both univariate and multivariate logistic regression analysis, only B-cells higher than 10/µL before boost or revaccination were associated with seroconversion (p= 0.009 and p= 0.01, respectively). Seroconversion was independent of age, gender, diagnosis, cumulative RTX dose, RTX treatment time, and time since last RTX treatment.

CONCLUSION:

Continuously impaired humoral response to mRNA vaccines was found in most RTX treated patients after a booster dose or revaccination. Seroconversion was observed in approximately one-third of the patients. Measurable B-cells before boosting or revaccination was the strongest predictor of antibody response after boost or revaccination.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study Topics: Vaccines Language: English Journal subject: Rheumatology Year: 2022 Document Type: Article Affiliation country: Rheumatology

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study Topics: Vaccines Language: English Journal subject: Rheumatology Year: 2022 Document Type: Article Affiliation country: Rheumatology