Rituximab timing of Covid2 vaccination

[AgedCrone]

This might interest those on Rtx who are due a Covid vaccination……medwireNews:

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.

For the first study, Xavier Mariette (Hôpital Bicêtre, Paris, France) and colleagues evaluated data from 24 rituximab-treated patients with immune-mediated inflammatory diseases (IMIDs), 35 patients on other immunosuppressants for IMIDs, and 26 age- and sex-matched healthy controls who received two doses of the Pfizer–BioNTech (BNT162b2) vaccine. The most common IMID diagnosis was rheumatoid arthritis (RA; 44%), followed by Sjögren’s syndrome (25%).

Overall, average levels of immunoglobulin (Ig)G antibodies against the SARS-CoV-2 spike protein at 1 month after the second vaccine dose were significantly lower among rituximab-treated patients than those on other immunosuppressants or healthy controls, at 69 versus 180 and 235 units/mL, respectively.Among the RA patients, the median time from the last rituximab infusion was 267 days for responders, decreasing to 137 days for those with a weak response (anti-spike antibody concentration 5–69 units/mL), and 107 days for nonresponders (<5 units/mL). Multivariable analysis demonstrated that longer time since rituximab infusion was significantly associated with vaccine response (odds ratio [OR]=2.97 for each additional 100 days), as was receipt of the Pfizer–BioNTech vaccine (OR=9.12 vs Moderna).

[Neonkittie17]

My igG & IgM have been scuppered by Rtx/ hypogamma so my immunoglobulins aren’t great at all. It took 14 months to get my B cells back post last Rtx in April 2021 and 18 months for a small vaccine response. Still trying to get more positive immune responses. My immunologist has always said that for many people leaving 6 months after Rtx to get your vaccine is still not enough despite the advice given generally. I am the proof of that. Is 267 about 9.5 months? .. as that’s more realistic for repopulation of B cells. Wasn’t long enough for me though.

[Neonkittie17 in reply to Neonkittie17]

267 days = 8.7 months

[AgedCrone in reply to Neonkittie17]

Well I had a rituximab infusion this week - 15 months after the last one, so I shan’t be having any vaccinations any time soon!

I think the Influenza jab in October might be my next jab.

[Neonkittie17 in reply to AgedCrone]

I waited over a year -after Rtx from 2021-22 to restart my Covid vaccines once my B cells showed to an acceptable level. I have just had my functional antibodies tested this week to see if the flu and pneumonia shots worked in the autumn. The year before with having had Rtx 6 months prior I didn’t get any response. (However I was told my tetanus shot from 20 years ago is still working well! Different kind of vaccine though.) I can pause my current biologic med to get my booster.

[AgedCrone in reply to Neonkittie17]

I’m working on the fact that I had Covid …I got over it and I’m fine so I’m not worried about having any more of the present vaccinations on offer.

Presumably - eventually an annual vaccination will be offered, like the influenza vaccination and I will probably have that.

But to be honest, the reactions I had to the first two Astrazeneca vaccinations were far worse than actually having Covid.

[Evie3 in reply to Neonkittie17]

Your medical team are certainly looking after you 👏👏. I have given up asking for specific BT’s now. Just trying to get on with life best I can. Take care

[Neonkittie17 in reply to Evie3]

The consultants have been trying very much, yes. It’s taken ages/3-4 years for me to ensure things have happened (I had to wait 18 months to change my biologic due to my immune not being strong enough ) so it’s with a lot of patience/tolerance/initiative too on my part. At the mo it’s much harder to get some things sorted out but I will keep trying.

BT as in blood tests? I have many issues trying to get some of mine requested/done/processed and spent all of Wednesday trying to sort a problem out so it’s not all plain sailing. I’d like to be free of the extra things to do so often I have to take a break from juggling 4 consultants. That will calm down eventually to as it was before. There are people I know and on here with much more to sort out so I’m just plodding on and doing lots of good things too away from medical essentials. Keeping a balance wherever possible, Hope you get some support for what you need. I always get better result from emailing the consultants via their Secretaries. Take care. 💗

[ks1966 in reply to Neonkittie17]

me again :). What type of tests do you do to see b cell levels and pneumonia vacc response. I’m willing to go private for this. It seems the Rhemuy team are punching in the dark and guessing

[Neonkittie17 in reply to ks1966]

If you’re are on Rtx you should have these done around each infusion as they are an essential part of the monitoring. They should let you have a “functional antibodies” blood test for your flu and pneumonia vaccines to see if they’ve worked.

[bpeal1 in reply to Neonkittie17]

I have immunoglobulin levels tested before each round of Rituximab but never had any specific antibody tests.

[Neonkittie17 in reply to bpeal1]

You should be having your Immunoglobulins IgG. IgM & IgA tested too as part of Rtx monitoring. Rtx, as a B cell depletor in turn can lower your immunoglobulins. Maybe the rheumy dept are doing this but haven’t told you? I get my blood results sent to me by post as the App doesn’t detail any immunology blood tests.

[bpeal1 in reply to Neonkittie17]

Yes I have all the immunoglobulins tested before each round but I’ve never had flu or pneumonia antibodies tested.

[Neonkittie17 in reply to bpeal1]

Sorry thought I’d replied but don’t think it posted. That was my rheumy who told me to have my functional antibodies tested. Not my request. She suspected I’d not have a vaccine response to flu or pneumonia vaccines and was right.

[ks1966 in reply to Neonkittie17]

thank you soooo much

[Neonkittie17 in reply to ks1966]

You’re welcome and hope the link/website helps explain.

[65_women in reply to Neonkittie17]

so what happens if your B cells are depleted and they want you to take Rix?

[Neonkittie17 in reply to 65_women]

Not sure how you mean .. if you think you’re not needing another Rtx yet as the previous one is still having good effect, but the rheumy wants you to have it? You’d need to ask your rheumy or nurse. You are usually given a repeat of Rtx when your B cells show signs of repopulation.

If the lack of B cells results in your immunoglobulins being too low on a regular basis then the rheumys don’t usually want you to repeat Rtx whilst they are too low as your immune could be overly compromised re being susceptible to infections. You would need to discuss individually the situation re your own immune/health/blood results.

[65_women in reply to Neonkittie17]

been there done she won’t listen

[Neonkittie17 in reply to 65_women]

Anyone else than her you can see/speak to? Don’t know what else to say. 😑🤷‍♀️

[ks1966 in reply to Neonkittie17]

hello. Can you please explain to me what is the difference between B cells and immunoglobulins. I find so confusing. Thank you

[Neonkittie17 in reply to ks1966]

Have a look on here as it’s better/easier for you to look at something official, but basically your B cells mature into immunoglobulins. Well, they do if they’re working properly.

immunology.org/public-infor...

[Neonkittie17]

I want my boosters. Haven’t caught up with them just yet. It’s up to each how they feel re their level of immunity (I have hypogamma and chronic bronchitis due to that, so I’m going to have the vaccines) and any other comorbidities. I understand that AZ isn’t used now.

[AgedCrone in reply to Neonkittie17]

But I am remaining on rituximab. I had an infusion last Wednesday, so I am not going to have anything to lessen the effect of that.

[Neonkittie17 in reply to AgedCrone]

I don’t have the Rtx/vaccines problem any more as I don’t have Rtx anymore but its effects are still there, both good and bad. Fortunately the vaccines didn’t affect the efficacy of Rtx for me.

[cathie]

that looks really relevant to me but can you translate it into something I can understand? Just the general?

[bpeal1 in reply to cathie]

The average length of time left between Rituximab and covid vaccinations to get a good response was 267 days (8.8months).

The average gap between Rituximab and vaccination for those who had a weak response was 137 days (4.5 months).

For those who made no (or very, very little) response to the vaccine the average gap was 107 days (3.5 months).

The conclusion from the study was the longer you wait after Rituximab before covid vaccination the better the response.

[cathie]

thanks. I find I can understand the words in docs like this but have no idea where they’re going!!

[AgedCrone in reply to cathie]

His .Cathie, I don’t go into my treatment in great detail….thankfully my rheumy does & he has kept me on an even keel for many years.

I take it to mean I should continue to leave as long as possible between having a Rtx infusion & a Covid vaccination.I went 15 months this last time because other health problems precluded Rtx & I had the quickest infusion - 51/2 hrs - since I started having it 6 years ago.

The only difference is I’m still very tired after 3 days which is unusual for me….but I take it as a great excuse to do things I want..not have …to do!

[cathie in reply to AgedCrone]

What you're saying is very interesting to me. If you managed 15 months then you might encourage me to try! My rheumy suggested I send them an SOS once I started feeling I needed it. I've just had my 7th covid jag, so my main question is going to be the opposite, how long to wait for the next infusion. I find that once someone asks me how I'm feeling I immediately start noticing the various aches and pains, which I've been putting on the back burner until then! Sometimes having a rest when very tired can bring you back to energy - after a day and a half of being semi-comatose after the jag, I've been doing things I've put off for months! XX

[AgedCrone in reply to cathie]

Well…I had an infusion what I considered then…..& still do…….far too soon after a vaccination…..that was about 9 weeks…& that infusion never had the usual almost immediate affect…but then I went 15 months…..until my next infusion……but I ‘d had other analgesics for a vertebrae fracture….so pain was not the main issue.

My rheumy advised that that as long as my blood tests didn’t show anything alarming ...& I could continue without undue discomfort …..I should soldier on & only have the infusion when everything else had settled down.

Will now see how things go with just the infusion to rely on. I think we will all have slightly different time scales depending on what is going on with our individual situation.

[cathie in reply to AgedCrone]

exactly. It’s good to hear about others experiences though

[Leics]

Thanks for the info interesting to know. I have severe hypogamma as a result of Rtx too. I’ve had four covid vaccines and when I got covid in January I decided to check my antibodies after about a month and they were >25k more likely down to getting covid than vaccination. I also had a pneumovax 2 for functional antibodies and failed miserably once again. So I won’t be having a booster for covid this spring.

[cathie]

Thanks for your clarification which helps immensely.. Before I received it, I showed this to my partner who is a medical statistician and says this about those studies. He's working on a project about people who are immunocompromised and how they respond to covid vaccines. He says this - mainly about the small numbers in the studies cited.

'This says that, among those who received rituximab followed by vaccine, those who mounted a good vaccine response had on average received the vaccine 9 months after rituximab; those who mounted a weak response had it 5 months after rituximab on average; and those who mounted no response had the vaccine 3 months after. It says that every additional 3 month gap increases your chance of the vaccine working threefold, and that Pfizer is better than Moderna. BUT the numbers are pretty small….'

[AgedCrone in reply to cathie]

Yes it was only a small study …but it was recent & confirms the larger, older, research results.

Once I’d had Covid and was relieved to find although elderly and on rituximab, I only had it mildly. I decided I was not going to go ahead with this latest offered vaccination …my Rheumatologist supported that decision and I will now see what his advice is come the autumn.

[cathie]

I guess that's the best way to find out isnt it!

[AgedCrone in reply to cathie]

I didn’t think so over Christmas…. half my food meant for the Christmas. Festivities …..is still in the freezer!!