Rituximab and covid vaccination

[Galaxy2]

Hi All

I have a dilemma and would be interested if anyone can help with information. I am due to have rituximab infusions starting next week which are overdue and I haven't had any infusions since January.

It was suggested earlier in the year that I delay the infusions for as long as possible unless I felt in need, I had a bad spell and so decided in September I would go ahead and I'm booked in from this coming week.

My specialist's recent suggestion was that I wait until I could have the vaccine but at the time I felt this could be months away for me as even though I'm in the extremely vulnerable group, age wise I'm not in a priority group. The news tonight sounds promising however that I could be having the vaccine much sooner than I thought and so I'm wondering if I would be better waiting for the vaccine than having my infusions?

Does anyone know if by having rituximab first if that could affect the vaccines response or if I have the vaccine and then my rituximab infusions could that wipe out the vaccine's effectiveness.

So hard to know what to do for the best, any information is really appreciated.

Thanks All

[PMRpro]

NO-ONE knows - they haven't done the work yet. I would discuss it wth the rheumy - to some extent it depends on how much you need the infusion. No point waiting indefinitely and the illess getting worse in the meantime.

[Duckett]

My consultant said to wait at least three months after Rituximab before having the vaccine.

[AmyS1]

Talk to your specialist nurse but I think no one knows. I doubt very much that the vaccine will be given to all CEV Clinically Extremely Vulnerable this year!!

[Clay6852]

Maybe it would be the same as having the flu vaccine. In which we must make sure it’s not a live vaccine and wait at least 3 months after rituximab. I’m having my infusion in 4 weeks time and not waiting. I would rather shield myself longer , keep the disease in check, then have vaccine .

[Investigator1]

It’s a really good question Jenny, I say that because 2 days ago I completed my first course of Rituximab and asked the same question and there seemed to be a general vagueness in the air. I am still confused whether the vaccine will produce an immune response because I have heard conflicting views on the different vaccines. I am not under a rheumatologist but a renal expert who is brilliant, she deals with a lot of people with low immune systems because of kidney transplants etc and has kept me right since I was diagnosed with GPA 11 months ago. I am seeing her in a week so will ask her the question as I have full confidence in her. If both can’t be taken and it becomes a choice then my advice is do what you need most, you made the decision to have Rituximab so stick with it to treat the priority......don’t get ill. Nick.

[Galaxy2 in reply to Investigator1]

Thanks Nick, yes so much conflicting information it seems, I think I will go ahead with the infusions, who knows how quickly the vaccine will be rolled out in reality and I could delay and the infection rate could be even higher when I'm next booked in too. Can I ask did you feel comfortable having the infusions in the current time? I am worried about having them at the moment, while I'm sure all precautions are being taken in hospitals while the infection rate is high I am concerned

Thanks

[Investigator1 in reply to Galaxy2]

To be honest Jenny there is nobody more windy than me when it comes to catching COVID but I have to say the nurses at the Renal centre basically kept contact to a minimum wore full face shields and set the timer on the blood pressure monitor, turned down the lights and left me to it. They made sure only one nurse was actually near me and that was just to turn up the infusion rate. I didn’t come away thinking what if........? I guess I also had confidence in the fact the renal centre is a relatively secure department because most people who are treated are on some kind are immune suppressed. The other reason why I suggested to take the infusion was (and it may be different where you are) I was told that if the infection rate continues to rise as we get into winter they could stop more hospital procedures and I didn’t want to risk that as my GPA levels have been rising steadily because Azathioprine didn’t suit me. But look, you will be fine you seem a really intelligent and sensible person, just stay positive and we will kick it out together. Nick.

[Galaxy2 in reply to Investigator1]

Thanks so much Nick, that's reassuring to know. Yes I'm sure all will be fine and will carry on shielding. I do hope you notice the benefits of your treatment soon, rituximab for me has made a huge difference to my health. Lets hope too that we all get positive news on the vaccine soon

[gooseflight]

The RNA vaccines are not live vaccine so that isn't an issue.

The question I have is will any of the RNA vaccines work for anyone receiving rituximab (or similar biologics)? RTX is designed to deplete B cells and by corollary T cells.

The RNA vaccines are intended to elicit a T cell response. Will anyone undergoing RTX treatment see that response? And, as you are asking, if someone receives the vaccine and builds some immunity, will it be wiped out by RTX?

It's a difficult one and I don't think there is a simple answer as the effect of RTX on immunity scope is not fully understood.

I was speaking to my renal consultant the other day about this (I am on RTX), and her advice was let other people have the vaccine first I actually think that's a good idea. In your position I would have your infusion to get on top of your condition and look after yourself for a few months. In the meantime, others will receive the vaccine and herd immunity *via vaccination* will develop.

Also, this looks interesting: bbc.co.uk/news/health-55022288

DISCLAIMER: I am not medically qualified.

[amms43 in reply to gooseflight]

Gooseflight, thank you for the BBC link. I too heard that at the time. It sounds more positive for those of us with compromised immune systems. I responded to Chris Bromsgrove's post but had not yet found yours.

[Paprika60]

I don't think anybody knows including the doctors. The only thing is the possible great news of the antibody treatment from Oxford team specially designed for the immune compromised people like us. I heard the news this morning. Not for the general public as it is much more costly. So it would be much better to stay cautious and stay safe. I am going to wait for this antibody treatment, not the vaccine.

[DazVin]

Hi Jenny,

I can only go on what I was told....I had my latest Rituximab in August and I asked about the "normal" Flu jab, they suggested I wait 12 weeks from my infusion before having this.

[Galaxy2]

Thanks everyone, really appreciate all your replies. So many unknowns at the moment around the vaccine, great that a vaccine has been produced so quickly though, we will just have to wait for further information to emerge

[sadlady66]

I had my rituximab infusion on 03/22/21 and my first Covid vaccine on 04/03/21 and so far I have not had any problems. I received the ok from my RA doctor. Hope this helps.