Correspondence on ‘Immunogenicity and safety of anti-SARS-Cov-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort’

Salviani, Chiara; Scolari, Francesco; Alberici, Federico

doi:10.1136/annrheumdis-2021-220496

Cited by 12 publications

(4 citation statements)

References 12 publications

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“…Anti-CD20 (rituximab) therapy depletes B cells with decreased humoral immune response to recall antigens. Our data are in line with others showing that rituximab affects neutralizing antibodies to COVID-19 vaccination [ 12–14 ]. We proved that in RA patients undergoing treatment with rituximab, even in patients receiving three doses of SARS-CoV-2 vaccinations, the neutralizing antibodies are still significantly lower than in healthy controls.…”

Section: Discussionsupporting

confidence: 93%

Rituximab, but not other biologics, impairs humoral immunity in patients with rheumatoid arthritis—a study using CoVariant protein arrays

Lin,

Du,

Tsai

et al. 2023

Rheumatology Advances in Practice

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Objectives Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and joint destruction. Biologics are crucial to achieving treat-to-target goals in patients with RA. The global spread and continuous variation of SARS-CoV-2 necessitate monitoring variant-specific humoral responses post-vaccination. This study aims to investigate how different biologic treatments for vaccinated RA patients may affect their neutralizing antibodies against multiple SARS-CoV-2 variants. Methods We recruited RA patients who had received three doses of conventional SARS-CoV-2 vaccines and were treated with various biologics, e.g., TNF inhibitor (etanercept), IL-6 inhibitor (tocilizumab), CTLA4-Ig (abatacept) or anti-CD20 (rituximab). Serum samples were used to profile the binding and neutralizing antibodies using our own SARS-CoV-2 variant (CoVariant) protein array, developed previously. Results Compared to healthy controls, only RA therapy with rituximab showed a reduction in neutralizing antibodies capable of targeting spike proteins in SARS-CoV-2 wild-type and most variants. This reduction is not observed in binding antibodies against SARS-CoV-2 wild-type or its variants. Conclusions After receiving three doses of SARS-CoV-2 vaccination, RA patients who underwent Rituximab treatment generated sufficient antibodies but exhibited lower neutralizing activities against wild-type and multiple variants, including current Omicron. Other biological DMARDs, e.g., TNF inhibitor, IL-6 inhibitor, and CTLA4-Ig, did not show obvious inhibition. Lay summary What does this mean for patients ? This research examined the impact of various biologic treatments (a type of drug) on the immune response of rheumatoid arthritis (RA) patients to COVID-19 vaccination. The study revealed that RA patients treated with rituximab had significantly lower levels of neutralizing antibodies against various SARS-CoV-2 variants, including Omicron, even after receiving three vaccine doses. Neutralizing antibodies defend the body from organisms that cause disease, such as viruses, by preventing them from entering our cells. In contrast, RA patients receiving other biologic therapies, including TNF inhibitors, IL-6 inhibitors, or CTLA4-Ig, did not experience the same reduction in neutralizing antibodies. No significant difference was found in serum antibodies, regardless of the specific biologic therapy (TNF inhibitors, IL-6 inhibitors, CTLA4-Ig, or anti-CD20). This study highlights the different immune responses to COVID-19 vaccination in patients with RA treated with various biologics. Therefore, individuals with RA who are considering or are currently undergoing biologic treatment should engage in thorough discussions with their healthcare providers regarding vaccination strategies. In summary, this study underscores the necessity for personalized vaccination strategies for RA patients based on their specific treatment regimens to ensure robust protection against evolving COVID-19 variants.

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Section: Discussionsupporting

confidence: 93%

Rituximab, but not other biologics, impairs humoral immunity in patients with rheumatoid arthritis—a study using CoVariant protein arrays

Lin,

Du,

Tsai

et al. 2023

Rheumatology Advances in Practice

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“… 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 28 articles were excluded with the following reasons: (1) insufficient data of outcomes, 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 (2) duplicate publications from an overlapping cohort, 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 and (3) case series or cohorts with < 10 patients. 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 A flow diagram of the article selection process is shown in Figure 1 , and the characteristics of each study are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

COVID-19 mRNA Vaccine in Patients With Lymphoid Malignancy or Anti-CD20 Antibody Therapy: A Systematic Review and Meta-Analysis

Ito¹,

Honda²,

Kurokawa³

2022

Clinical Lymphoma Myeloma and Leukemia

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“…Deepak et al 20 concluded that BCDT has the most prominent effect on antispike protein immunoglobulin G and neutralization titers in the 6 months after dosing, whereas other case series have observed that patients receiving regular rituximab have failed to mount any detectable antibody response, even with a 6-month interval between rituximab dosing and vaccination. 29,30 One of these case series, Salviani et al 29 highlighted 2 cases of patients receiving rituximab for antineutrophil cytoplasmic antibody-associated vasculitis. Although both patients received their last dose of rituximab approximately 7 months prior to vaccination, neither had recovered B-cell counts at time of vaccination and subsequently did not produce a detectable immune response.…”

Section: The Impact Of Biologic Therapy On Response To Covid 19 Vaccines B-celledepleting Therapiesmentioning

confidence: 99%

COVID-19 vaccine safety and efficacy in patients with immune-mediated inflammatory disease: Review of available evidence

Wack

Patton

Ferris

2021

Journal of the American Academy of Dermatology

101

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Dermatologists diagnose and treat many immune-mediated inflammatory diseases (IMID). Understanding the inherent immune dysregulation of these diseases as well as the additional disruption that comes as a result of IMID treatments has been important during the COVID-19 pandemic. With vaccines becoming widely available, dermatologists need to be familiar with the risks and benefits of vaccination in these patients, particularly those taking biologics, in order to have informed discussions with their patients. In this review, we present the current evidence related to COVID-19 vaccine safety and efficacy in patients with IMID and review existing recommendations for vaccination against SARS-CoV-2. Given the current evidence, there is minimal concern that these patients are at any greater risk of harm from COVID-19 vaccination compared to healthy controls. For most, the benefit of avoiding severe COVID-19 through vaccination will outweigh the theoretical risk of these vaccines. A question that is still outstanding is whether patients on biologics will generate a sufficient immune response to the vaccine, which may be dependent on the specific biologic therapy and indication being treated. This underscores the importance of following patients with IMID after vaccination to determine the safety, efficacy, and duration of the vaccine in this population.

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Correspondence on ‘Immunogenicity and safety of anti-SARS-Cov-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort’

Cited by 12 publications

References 12 publications

Rituximab, but not other biologics, impairs humoral immunity in patients with rheumatoid arthritis—a study using CoVariant protein arrays

Rituximab, but not other biologics, impairs humoral immunity in patients with rheumatoid arthritis—a study using CoVariant protein arrays

COVID-19 mRNA Vaccine in Patients With Lymphoid Malignancy or Anti-CD20 Antibody Therapy: A Systematic Review and Meta-Analysis

COVID-19 vaccine safety and efficacy in patients with immune-mediated inflammatory disease: Review of available evidence

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