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Lu L, Chan CY, Lim YY, Than M, Teo S, Lau PYW, Ng KH, Yap HK. SARS-CoV-2 Humoral Immunity Persists Following Rituximab Therapy. Vaccines (Basel) 2023; 11:1864. [PMID: 38140267 PMCID: PMC10748262 DOI: 10.3390/vaccines11121864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Long-term humoral immunity is mediated by short-lived plasma cells (replenished by memory B cells) and long-lived plasma cells. Their relative contributions are uncertain for immunity to SARS-CoV-2, especially given the widespread use of novel mRNA vaccines. Yet, this has far-reaching implications in terms of the need for regular booster doses in the general population and perhaps even revaccination in patients receiving B cell-depleting therapy. We aimed to characterise anti-SARS-CoV-2 antibody titres in patients receiving Rituximab following previous SARS-CoV-2 vaccination. We recruited 10 fully vaccinated patients (age: 16.9 ± 2.52 years) with childhood-onset nephrotic syndrome, not in relapse, receiving Rituximab for their steroid/calcineurin-inhibitor sparing effect. Antibodies to SARS-CoV-2 spike (S) and nucleocapsid (N) proteins were measured immediately prior to Rituximab and again ~6 months later, using the Roche Elecys® Anti-SARS-CoV-2 (S) assay. All ten patients were positive for anti-S antibodies prior to Rituximab, with six patients (60%) having titres above the upper limit of detection (>12,500 U/mL). Following Rituximab therapy, there was a reduction in anti-S titres (p = 0.043), but all patients remained positive for anti-S antibodies, with five patients (50%) continuing to have titres >12,500 U/mL. Six patients (60%) were positive for anti-N antibodies prior to Rituximab. Following Rituximab therapy, only three of these six patients remained positive for anti-N antibodies (p = 0.036 compared to anti-S seroreversion). Humoral immunity to SARS-CoV-2 is likely to be mediated in part by long-lived plasma cells.
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Affiliation(s)
- Liangjian Lu
- Department of Paediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore (S.T.); (K.H.N.); (H.K.Y.)
| | - Chang Yien Chan
- Department of Paediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore (S.T.); (K.H.N.); (H.K.Y.)
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore;
| | - Yi Yang Lim
- Department of Paediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore (S.T.); (K.H.N.); (H.K.Y.)
| | - Mya Than
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore;
| | - Sharon Teo
- Department of Paediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore (S.T.); (K.H.N.); (H.K.Y.)
| | - Perry Y. W. Lau
- Department of Paediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore (S.T.); (K.H.N.); (H.K.Y.)
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore;
| | - Kar Hui Ng
- Department of Paediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore (S.T.); (K.H.N.); (H.K.Y.)
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore;
| | - Hui Kim Yap
- Department of Paediatrics, Khoo Teck Puat - National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore (S.T.); (K.H.N.); (H.K.Y.)
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore;
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Schiff AE, Wang X, Patel NJ, Kawano Y, Kowalski EN, Cook CE, Vanni KM, Qian G, Bade KJ, Saavedra AA, Srivatsan S, Williams ZK, Venkat RK, Wallace ZS, Sparks JA. Immunomodulators and risk for breakthrough infection after third COVID-19 mRNA vaccine among patients with rheumatoid arthritis: A cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.08.23296717. [PMID: 37873462 PMCID: PMC10592996 DOI: 10.1101/2023.10.08.23296717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives To investigate COVID-19 breakthrough infection after third mRNA vaccine dose among patients with RA by immunomodulator drug class, and we hypothesized that CD20 inhibitors (CD20i) would have higher risk for breakthrough COVID-19 vs. TNF inhibitors (TNFi). Methods We performed a retrospective cohort study investigating breakthrough COVID-19 among RA patients at Mass General Brigham in Boston, MA, USA. Patients were followed from the date of 3rd vaccine dose until breakthrough COVID-19, death, or end of follow-up (18/Jan/2023). Covariates included demographics, lifestyle, comorbidities, and prior COVID-19. We used Cox proportional hazards models to estimate breakthrough COVID-19 risk by immunomodulator drug class. We used propensity score (PS) overlap-weighting to compare users of CD20i vs. TNFi. Results We analyzed 5781 patients with RA that received 3 mRNA vaccine doses (78.8% female, mean age 64.2 years). During mean follow-up of 12.8 months, 1173 (20.2%) had breakthrough COVID_19. Use of CD20i (adjusted HR 1.74, 95%CI 1.30-2.33) and glucocorticoid monotherapy (adjusted HR 1.47, 95%CI 1.09-1.98) were each associated with breakthrough COVID-19 compared to TNFi use. In the PS overlap-weighted analysis, CD20i users also had higher breakthrough COVID-19 risk than TNFi users (HR 1.62, 95%CI 1.02-2.56). A sensitivity analysis excluding patients with cancer or interstitial lung disease yielded similar findings. Conclusions We identified CD20i and glucocorticoid monotherapy as risk factors for breakthrough COVID-19 among patients with RA after a 3rd vaccine dose. This contemporary study highlights the real-world impact of blunted immune responses in these subgroups and the need for effective risk mitigation strategies.
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Affiliation(s)
- Abigail E. Schiff
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| | - Xiaosong Wang
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Naomi J. Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Harvard Medical School, Boston, MA
| | - Yumeko Kawano
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| | - Emily N. Kowalski
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Claire E. Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA (The Mongan Institute, 100 Cambridge Street, Suite 1600, Boston, MA, 02114)
| | - Kathleen M.M. Vanni
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Grace Qian
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Katarina J. Bade
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Alene A. Saavedra
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Shruthi Srivatsan
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Zachary K. Williams
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Rathnam K. Venkat
- Tufts University School of Medicine, Boston, MA, USA (145 Harrison Ave, Boston, MA 02111)
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Harvard Medical School, Boston, MA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA (The Mongan Institute, 100 Cambridge Street, Suite 1600, Boston, MA, 02114)
| | - Jeffrey A. Sparks
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
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