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B Cell Reconstitution is Associated With COVID-19 Booster Vaccine Responsiveness in Patients Previously Seronegative Treated With Rituximab.
Schultz, Kaitlin; Jannat-Khah, Deanna; Spiera, Robert.
  • Schultz K; K. Schultz, BA, Department of Medicine, Hospital for Special Surgery.
  • Jannat-Khah D; D. Jannat-Khah, DrPH, MSPH, R. Spiera, MD, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
  • Spiera R; D. Jannat-Khah, DrPH, MSPH, R. Spiera, MD, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medical College, New York, New York, USA. spierar@hss.edu.
J Rheumatol ; 50(3): 420-425, 2023 03.
Article in English | MEDLINE | ID: covidwho-2280248
ABSTRACT

OBJECTIVE:

To assess factors associated with serologic response to the coronavirus 2019 (COVID-19) booster vaccine in patients with autoimmune rheumatic diseases treated with rituximab (RTX) who were previously serologically unresponsive to the initial vaccine series.

METHODS:

A retrospective chart review of patients treated with RTX who failed to demonstrate a serologic response to the first SARS-CoV-2 vaccination series and subsequently received an mRNA vaccine booster was performed. Serologic response ≥ 4 weeks after the booster was the primary outcome. Fisher exact tests, t tests, and Wilcoxon rank-sum tests were used for comparisons.

RESULTS:

In 31 patients who were previously seronegative, 68% seroconverted following a booster of the COVID-19 vaccine. B cell reconstitution was significantly different between those with positive (median 1.79, IQR 0.65-3.00) and negative (median 0, IQR 0-0) serologic responses to the booster. The days from last RTX dose were also statistically different among seroconverters (median 301, IQR 251-368) vs nonseroconverters (median 188, IQR 169-245). Demographic characteristics were not associated with serologic positivity. Positive predictive value of B cell presence was 90.9% (95% CI 70.8-98.9) and negative predictive value was 100% (95% CI 59-100) for serologic response to the mRNA booster vaccine. Positive predictive value of time ≥ 6 months from last RTX dose to booster was 78.3% (95% CI 56.3-92.5) and the negative predictive value was 62.5% (95% CI 24.5-91.5).

CONCLUSION:

Detectable B cells and longer time from last RTX exposure were associated with the development of anti-SARS-CoV-2 spike protein antibodies following the booster vaccine. These findings should be considered in timing boosters in patients treated with RTX.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Autoimmune Diseases / COVID-19 Type of study: Observational study / Prognostic study Topics: Vaccines Limits: Humans Language: English Journal: J Rheumatol Year: 2023 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Autoimmune Diseases / COVID-19 Type of study: Observational study / Prognostic study Topics: Vaccines Limits: Humans Language: English Journal: J Rheumatol Year: 2023 Document Type: Article