Trajectories of humoral and cellular immunity and responses to a third dose of mRNA vaccines against SARS-CoV-2 in patients with a history of anti-CD20 therapy. Issue 1 (31st March 2022)

• Record Type: Journal Article
• Authors: Sidler, Daniel; Born, Alexander; Schietzel, Simeon; Horn, Michael P; Aeberli, Daniel; Amsler, Jennifer; Möller, Burkhard; Njue, Linet M; Medri, Cesare; Angelillo-Scherrer, Anne; Borradori, Luca; Seyed Jafari, S. Morteza; Radonjic-Hoesli, Susanne; Chan, Andrew; Hoepner, Robert; Bacher, Ulrike; Mani, Laila-Yasmin; Iype, Joseena Mariam; Suter-Riniker, Franziska; Staehelin, Cornelia; Nagler, Michael; Hirzel, Cedric; Maurer, Britta; Moor, Matthias B
• Is Part Of: RMD open. Volume 8:Issue 1(2022)
• Publication Date: 2022-03-31
• Subjects: rituximab -- vaccination -- COVID-19 -- systemic vasculitis; Musculoskeletal system -- Diseases -- Periodicals; Rheumatism -- Periodicals; 616.7005
• DOI: 10.1136/rmdopen-2021-002166
• Languages: English
• ISSNs: 2056-5933

Abstract

Abstract : Background: The majority of patients with B-cell-depleting therapies show compromised vaccination-induced immune responses. Herein, we report on the trajectories of anti-SARS-CoV-2 immune responses in patients of the RituxiVac study compared with healthy volunteers and investigate the immunogenicity of a third vaccination in previously humoral non-responding patients. Methods: We investigated the humoral and cell-mediated immune response after SARS-CoV-2 messanger RNA vaccination in patients with a history with anti-CD20 therapies. Coprimary outcomes were antispike and SARS-CoV-2-stimulated interferon-γ concentrations in vaccine responders 4.3 months (median; IQR: 3.6–4.8 months) after first evaluation, and humoral and cell-mediated immunity (CMI) after a third vaccine dose in previous humoral non-responders. Immunity decay rates were compared using analysis of covariance in linear regression. Results: 5.6 months (IQR: 5.1–6.7) after the second vaccination, we detected antispike IgG in 88% (29/33) and CMI in 44% (14/32) of patients with a humoral response after two-dose vaccination compared with 92% (24/26) healthy volunteers with antispike IgG and 69% (11/16) with CMI 6.8 months after the second vaccination (IQR: 6.0–7.1). Decay rates of antibody concentrations were comparable between patients and controls (p=0.70). In two-dose non-responders, a third SARS-CoV-2 vaccine elicited humoral responses in 19% (6/32) and CMI in 32% (10/31) participants. Conclusion: This study reveals comparable immunity decay rates between patients with anti-CD20 treatments and healthy volunteers, but inefficient humoral or CMI after a third SARS-CoV-2 vaccine in most two-dose humoral non-responders calling for individually tailored vaccination strategies in this population. Trial registration number NCT04877496; ClinicalTrials.gov number.