TY - JOUR
T1 - Rituximab-treated rheumatic patients
T2 - B cells predict seroconversion after COVID-19 boost or revaccination in initial vaccine non-responders
AU - Ammitzbøll, Christian
AU - Kragh Thomsen, Marianne
AU - Bøgh Andersen, Jakob
AU - Jensen, Jens Magnus Bernth
AU - From Hermansen, Marie-Louise
AU - Johannsen, Anders Dahl
AU - Larsen, Mads
AU - Mistegaard, Clara Elbæk
AU - Mikkelsen, Susan
AU - Szabados, Fruzsina
AU - Vils, Signe Risbøl
AU - Erikstrup, Christian
AU - Hauge, Ellen-Margrethe
AU - Troldborg, Anne
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Objectives: To investigate the effect of either a booster vaccine (one dose) or revaccination (two doses 3 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 6 weeks after the last vaccine dose. B cells (CD19
þCD45
þ) 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% 6 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/ml before boost or revaccination were associated with seroconversion (P ¼ 0.009 and P ¼ 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.
AB - Objectives: To investigate the effect of either a booster vaccine (one dose) or revaccination (two doses 3 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 6 weeks after the last vaccine dose. B cells (CD19
þCD45
þ) 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% 6 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/ml before boost or revaccination were associated with seroconversion (P ¼ 0.009 and P ¼ 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.
KW - Antibodies, Viral
KW - COVID-19/prevention & control
KW - Humans
KW - Immunization, Secondary
KW - Rituximab/therapeutic use
KW - SARS-CoV-2
KW - Seroconversion
KW - Vaccination
KW - Vaccines
UR - http://www.scopus.com/inward/record.url?scp=85165676707&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/keac666
DO - 10.1093/rheumatology/keac666
M3 - Journal article
C2 - 36445008
SN - 1462-0324
VL - 62
SP - 2544
EP - 2549
JO - Rheumatology
JF - Rheumatology
IS - 7
ER -