Correspondence on ‘SARS-CoV-2 vaccination in rituximab-treated patients: evidence for impaired humoral but inducible cellular immune response’

Abstract

The role of SARS-CoV-2-specific antibodies in COVID-19 is not well established: reports indicate an increased risk of severe COVID-19 infections in Rtx-treated patients, 7 whereas other data have suggested that B cells are dispensable for resolving such infections. 11 The here presented data indicate that polyfunctional antiviral T cell responses are raised after SARS-CoV-2 vaccination in this high-risk population suggesting protection in the absence of virus-specific antibodies.

B cell numbers predict humoral and cellular response upon SARS-CoV-2 vaccination among patients treated with rituximab

“…Protection through immunization is achieved by an orchestrated immune response between different cellular subsets of innate (APCs) and adaptive immunity, such as B and T cells. Anti-B cell therapies like anti-CD20 antibodies (rituximab, obinutuzumab and ocrelizumab) and BTK inhibitors are associated with poor humoral SARS-CoV-2 vaccination responses, in patients with AIIRD [17][18][19][20] , multiple sclerosis 26 and CLL 27 . Since B cell depletion enhances the risks for poor Covid-19 outcomes 3 , but also can reduce anti-SARS-CoV-2 vaccine responses, it is of utmost importance to delineate the level of B cell repopulation necessary to achieve anti-vaccine responses and get insights into the complex relationship between antigen-specific B and T cells.…”

“…However, in particular under B cell depleting therapy with RTX, hampered humoral and cellular responses following influenza, pneumococcal and hepatitis B vaccination have been reported [11][12][13][14][15][16] . Data available about SARS-CoV-2 vaccine response in rituximab treated AIIRD patients reveal substantially impaired humoral [17][18][19] but partly inducible cellular immune responses 20 . However, little is known about the complex mechanisms between T, B and plasma cells, as well as the level of B cell repopulation necessary for proper vaccine response among RTX patients.…”

Anti-COVID-19 Vaccination in Patients with Autoimmune-Autoinflammatory Disorders and Primary/Secondary Immunodeficiencies: The Position of the Task Force on Behalf of the Italian Immunological Societies

“…Thus, (even with mRNA vaccines) analogous to what has been observed with traditional vaccines, patients with AIAIDs may present a reduced vaccine-induced immune response because of the disease itself as well as immunosuppressive therapy, with CCS and anti-CD20 mAbs nearly always implicated in the immunosuppressive effect. However, for anti-CD20 mAbs, the marked reduction of the antibody response is associated with substantial maintenance of the adaptive cellular immunity, as originally observed with the influenza vaccine [13] and recently confirmed with anti-COVID-19 vaccines [110], even towards some variants of concern, such as B.1.1.7 and B.1.351 [111]. All the authorized COVID-19 vaccines can stimulate specific cellular immunity (Table 4) Moreover, immunosuppressive treatment has even been associated in some studies, with a protective effect on the cytokine release syndrome [112] observed in some cases of SARS-CoV-2 infection.…”

SARS-CoV-2 and the rheumatology patient: the last 12 months and a boost in the future

“…In this themed issue of the Annals of the Rheumatic Diseases, focused on COVID-19 and SARS-CoV-2 vaccination in rheumatology, a number of papers have been assembled, which advance our understanding in this area and should allow for optimising the approach to this pandemic in the near future. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] To date, our understanding of COVID-19 risk in rheumatology comes primarily from observational registry-based cohorts. A clear signal has emerged in that patients receiving B-cell depletion therapy or high-dose glucocorticoids at baseline are at higher risk of more severe COVID-19 outcomes if infected.…”