A patient treated with rituximab may show an impaired response to COVID-19 vaccination (as well as other vaccines).
Patient selection: therapy with rituximab
Outcome: humoral response to vaccine
The primary predictor of poor response to vaccination was undetectability of B cells in the peripheral blood. Significant B-cells depletion affected 56% of rituximab-treated patients in the study.
Therapy with methotrexate or other agents may further reduce response to vaccination.
The spike in antibodies due to the vaccine correlated with peripheral blood CD19 counts.
If a patient is being treated with rituximab and if therre are no detectable B cells in the peripheral blood and if the disease is quiescent enough to allow interruption in rituximab therapy, then a strategy is to discontinue the rituximab and to vaccinate once B-cells are detectable in the peripheral blood.
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