Abstract
OBJECTIVES: In patients with RA treated with (ultra-)low-dose rituximab (RTX), we investigated the association of dosing and timing of RTX on seroconversion after a third coronavirus disease 2019 (COVID-19) vaccination and the persistence of humoral response after a two-dose vaccination. MATERIAL AND METHODS: In this monocentre observational study, patients from the COVAC cohort were included in the third vaccine analysis if humoral response was obtained 2-6 weeks after a third vaccination in previous non-responders and in the persistence analysis if a follow-up humoral response was obtained before a third vaccination in previous responders. Dichotomization between positive and negative response was based on the assay cut-off. The association between the latest RTX dose before first vaccination, timing between the latest RTX dose and vaccination and response was analysed with univariable logistic regression. RESULTS: Of the 196 patients in the cohort, 98 were included in the third vaccine analysis and 23 in the persistence analysis. Third vaccination response was 19/98 (19%) and was higher for 200 mg RTX users [5/13 (38%)] than for 500 and 1000 mg users [7/37 (19%) and 7/48 (15%), respectively]. Non-significant trends were seen for higher response with lower dosing [200 vs 1000 mg: odds ratio (OR) 3.66 (95% CI 0.93, 14.0)] and later timing [per month since infusion: OR 1.16 (95% CI 0.97, 1.35)]. Humoral response persisted in 96% (22/23) and 89% (8/9) of patients who received RTX between the two measurements. CONCLUSIONS: Repeated vaccination as late as possible after the lowest RTX dose possible seems the best vaccination strategy. A once positive humoral response after COVID-19 vaccination persists irrespective of intercurrent RTX infusion. Study registration. Netherlands Trial Registry (https://www.trialregister.nl/), NL9342.
| Original language | English |
|---|---|
| Pages (from-to) | 1627-1630 |
| Number of pages | 4 |
| Journal | Rheumatology |
| Volume | 62 |
| Issue number | 4 |
| Early online date | 24 Aug 2022 |
| DOIs | |
| Publication status | Published - 1 Apr 2023 |
Bibliographical note
Funding Information:We thank Kasper Jolink and the staff of the rheumatology outpatient clinic of the Sint Maartenskliniek for performing additional blood sampling for this study and Paul Daemen for performing the assays. C.J.T.v.d.T., D.F.T.C., B.J.F.v.d.B., N.d.B. and A.A.d.B. designed the study. C.J.T.v.d.T., D.F.T.C. and A.A.d.B. informed and included patients. J.R. supervised and interpreted the antibody measurements. C.J.T.v.d.T. had access to all the data and performed the statistical analyses. C.J.T.v.d.T., D.F.T.C. and A.A.d.B. drafted the manuscript. All authors critically revised the final version of the manuscript. The study was approved by the Ethics Committee of the Radboudumc CMO Arnhem-Nijmegen (protocol number 2021-7406) and the National Ethics Committee of the Netherlands CCMO (protocol number NL76709.091.21). The study was conducted in accordance with the Declaration of Helsinki and International Council for Harmonization Good Clinical Practice guidelines.
Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.
