Vaccination after Rituximab infusion.

[trenarren]

Hi, has anyone been advised on the best timing for the covid /flu booster after a Rituximab infusion? I believe it is 6 weeks minimum, but I am just wondering if its worth trying to delay it for a bit longer?

[AgedCrone]

I have been on Rtx since 2016 & have always been told to wait a minimum of 12 weeks post Infusion before having the Influenza vaccination….seems to have worked well for me…but I think a lot of people will have a different experience.

I think the Covid 19 vaccination timing is still work in progress. Best check with your rheumy team….they know your clinical details & will know what is likely to suit you best.

[trenarren in reply to AgedCrone]

Hi, luckily I have a Rhumy appointment on Monday, so will ask then, although I did ask last year and was advised 6 weeks! I will get back to you on what they advise this time! Agreed we are all different and react differently, but I'm suprised there isnt a blanket minimum by now.

[AgedCrone in reply to trenarren]

I’ve had 4 Covid vaccinations & I haven’t developed any anti bodies so I’m minded not to have a 5th….unless my rheumatologist violently disagrees.

I will have the Influenza vaccination….at least a month before I eventually get my Rtx infusion. But I honestly think there are now so many Covid variants it’s mostly guess work

But one thing I would say is even though my January Rtx infusion did not seem to work as usual..…my flare continued…..but it has now calmed down….so what to make of that is in the pending file.

I will be interested in the advice you will be given.

[Neonkittie17]

I was also told ideally wait 12 weeks after Rtx before having the flu vaccine, and see my reply on the other similar questions posted today re Rtx. It’s a headache juggling it I know. Good luck.

[trenarren in reply to Neonkittie17]

I do hope Rheumatology on Monday suggest at least 12 weeks, I can then tell the surgery that I need to wait longer, without fear of missing the vaccinations.

[Neonkittie17 in reply to trenarren]

I hope you can book your flu vaccine in advance. I’m not sure at the mo exactly when I’ll have mine as I’m due my first Covid booster w/c 5 October and just started a new biologic this week so I will have to come off that in three weeks for the booster. So maybe best to build up a bit of RA resistance for another few weeks before I then pause it again for the flu vaccine. (I’m no longer on Rtx and my last one was a year ago, but it’s still affecting my immunity (immunoglobulins.) It’s always juggling and trying to get the timing right for our meds and vaccines!

You can get a blood test after your flu vaccine to see if it’s worked. My rheumatologist advises to do this last year and despite 10 weeks wait after Rtx I didn’t have any response for my flu veccine. Also minimal response to the pneumonia one. 😑 The test is called “Functional Antibodies”. We’re all different and I hope you have a good response.

[trenarren in reply to Neonkittie17]

Thats good, I didn't know about the blood tests, I will mention that on my Monday appointment. I don't usually see my Rheumatologist, but will get the nurse to find out.

[Neonkittie17 in reply to trenarren]

It’s a straight forward blood test for the functional antibodies. If you test and don’t get any then flu vaccine season is probably over by the time you repopulate B cells to try again, so that’s frustrating too. I will ask my immunologist re flu vaccines and Rtx when I speak with him next in two weeks. I’ve only ever had one flu vaccine and that was the failed one last year.

[bpeal1]

Think you need to speak to your Rheumatology team as we've all been told different things. I have always been told to leave 4 weeks.

[AgedCrone in reply to bpeal1]

Rituximab and COVID-19 vaccination: Timing may be key for antibody responseAuthor: Claire BarnardshareprintinsitemedwireNews: Findings from two studies suggest that among rituximab-treated patients, those with a longer time since their last infusion may be more likely to have an antibody response to vaccines against SARS-CoV-2.

[bpeal1 in reply to AgedCrone]

It’s a juggling act. And very much depends on individual circumstances hence my advice to speak to Rheumatology team. In my case I live with two teenage children so I think my rheumatologist thinks some protection sooner is preferable to waiting longer for possibly better protection. However, I don’t have any other comorbities and I’m only mid-40s.

[trenarren in reply to bpeal1]

Yes, there probably isn't a correct answer. I have a Rheumatology appointment on Monday, so hopefully I will get some good advice.

[trenarren in reply to AgedCrone]

I caught Covid last June, and wasn't too bad with it. But my previous RTX infusion had been in May 2021, so I assume that's why, although I had had my 2nd, 3rd & 4th vaccinations before June!

I had my last RTX infusion 5 weeks ago & my 5th!! vaccination in April, (which has been very successful). I don't always see my Rheumatologist on appointments, I just hope I can get good advice!!

[AgedCrone in reply to trenarren]

How do you judge if your 5th vaccination has been successful?The fact that you haven’t caught Covid again?If that is why…….you might not have caught it again anyway….as having had it you could still have had some immunity….I think the answer now is to keep having the Covid vaccinations if they make you feel safe.Unless my rheumy can convince me..I think I will just have the Flu jab. 

[trenarren in reply to AgedCrone]

I believe that the vaccinations don't stop you actually catching it, but give you a better chance of reducing the fever. Catching it in June was a real shock, and I cant now say I wont catch it again. Hopefully the vaccinations will reduce the chance of getting really ill with it, if i catch it, especially after a RTX infusion.

[AgedCrone in reply to trenarren]

Yes you are right a CV19 vaccination does not stop you catching the virus, it ensures that your immune system has had prior sight of the virus, so can react  more speedily…..hence you get a less severe infection.But as you have actually been confirmed as having had Covid …that gives you a certain amount of immunity as well.But if you look up the research studies they are heavily weighted on the side of leaving a longer rather than a shorter gap between having a Rtx infusion & a vaccination.But as I think everyone agrees…listening to a doctor who is treating you is obviously the preferred way to decide on the timing. 

[Scholar90 in reply to AgedCrone]

Well…the main point of the Covid vaccine (as with *most* vaccines) is to reduce the severity of the illness and nearly eradicate the likelihood of death in the general population of those who take it. MOST vaccines (unlike Polio at the time since pretty much everyone took it) did/do not claim to keep every single person from getting a virus, but decreases severity, length of time a person is sick, and lowers risk of death.

[trenarren in reply to AgedCrone]

Hi, I understand your reply more now. I was meaning that my Rituximab treatment was very successful and reduced my flares even with all the vaccinations!

[AgedCrone in reply to trenarren]

I agree… but I wish I had never gone anywhere near Covid Vaccinations ….my last Rituximab infusion did not work - I have no antibodies and caring as he is - my rheumatologist like most doctors advising on Covid vaccinations doesn’t appear to have much more knowledge than we have.Although a lot of research says wait until until your B cells repopulate….most rheumatologists seem to say get vaccinated no matter what.

[Scholar90]

Hi There! I am currently on Rituxan and received my first two Covid vaccines and then a booster prior to my first infusion, then a second booster right after my first infusion. However, my rheumatologist told me upon scheduling my next Rituxan infusion that ANY patient who is using Rituxan, cellcept and similar therapies which greatly reduce the immune system & thus immune system response cannot take the regular Covid-19 boosters OR vaccines as they WILL NOT WORK. Our bodies will not be able to create any antibodies for them. So, right before my second infusion, I received something called EVUSHIELD: They are just TWO injections given in the glute muscle 15min apart on the same day, wait an hour to make sure there are no adverse reactions then you can leave.

It took me the entire day, but my reaction was EXTREME fatigue. And apparently that is the most common reaction. It also put me into a flare for several days. But PLEASE! Everyone make sure to get an EVUSHIELD if you’re taking Rituxan, cellcept or any of the medications on the list for EVUSHIELD (I can put the link I believe??) because the regular vaccines and boosters won’t work & thus you won’t be guarded at all against Covid.

My nurse who did my infusion this time was telling me that apparently, the sigh that a vaccine works and is creating antibodies is by having a slight reaction to it (even with a small headache, any muscle aches, anything that feels like getting sick) but if your body doesn’t even realize there’s been “an intruder” it didn’t work. The rxn is much less with a booster of course as the dosing is less, but still.

**I just read some articles about EVUSHIELD in the UK and the government has been refusing to purchase any of the medication & people have been trying to private pay for it! I’m so very sorry to hear that…It is available in the US, that is the only knowledge I have

I hope this helps!

Best!

[AgedCrone in reply to Scholar90]

Things work very differently in the UK Scholar90….we receive all necessary medical treatment free at the point of use,& quite rightly having enough money to pay to buy Covid vaccinations, incuding Evusheld, is not possible.

Your nurse’s remark that even a “slight reaction” to a Covid19 vaccination means it is working is sadly not correct. I had mega reactions to my first two CV vaccinations, but I still had no detectable antibodies…..although the vaccinations were given 7/8 months post my last Rituximab infusion….& my B cells normally start repopulating after 6 months. In fact if you read a lot of US research results this is a known fact…

As I understand the Evusheld position in the U.K. …it is that at the moment , it will not be used as a prophylactic, but it may be available as a treatment if thought therapeutically necessary if a vulnerable person does catch Covid 19……but I have not been following this decision closely so I may not be up to speed on that.

[Scholar90 in reply to AgedCrone]

Yes, I’m very aware of the differences in the UK with regards to affordable healthcare—I wish the USA were similar in that regard. However, we didn’t have to pay for Covid vaccines or the EVUSHIELD either up front or later, they’re free.

As far as my nurse goes—I relayed what she said in case others who took the vaccine close the their Rituxan or are on similar meds had the same issue. I had the vaccine with only a slight reaction and had antibodies, when I received the first booster I had NO noticeable symptoms but developed antibodies just fine. You stated you were 7/8 months post? So, Rituxan is normally out of your system after 6 months which is why the infusion is given every 6 months.

[Evie3]

Would b interested to know too. I have only been told Re: Ritux that Covid jabs etc must b 4 weeks before the infusion

[AgedCrone in reply to Evie3]

It depends how long your B cells repopulate after a Rtx infusion. in UK most NHS clinics do not check antibodies-I had mine tested privately because I had zero reaction to the infusion……. and there is no point me paying for more tests until there is much more known about the situation.So I am going ahead and having my influenza vaccination and hopefully will sort something out one month after that.

[trenarren in reply to AgedCrone]

I had a phone call yesterday from a Rheumatology nurse who said my later appointment (yesterday) was too soon after my last Infusion, can rebook for later date!!

I did ask her about the best date for covid/flu vaccination, she will get back to me!! I will update when I hear!

[AgedCrone in reply to trenarren]

Wouldn’t  it be nice to find a clinician who said “Right now we don’t know…but a lot of research indicates the longer the better”? That won’t happen & until it does we are all taking a leap in the dark…I’m leaping Yes to infusion, Yes to Flu vaccination & for the moment No to 5th Covid vaxx.If it turns out “I told you so”…..I’ll know I was wrong! 

[trenarren in reply to AgedCrone]

The rheumatology nurse contacted me today and said the advice is to wait 3 months after a rituximab infusion before you have a covid vaccination. I asked about the flu vaccination, she said she assumed it's the same.

[AgedCrone in reply to trenarren]

I think if you scroll back that is maybe what we said….wait 12 weeks = wait three months🙋‍♀️🙋‍♀️

You see us Brits are up to speed!

[madme1]

My infusion of Remsima is every 8 weeks so ive been advised to have the covid/flu vax in the middle. Ie 4wks after one and 4wks before the next.