Rituximab and fourth vaccine

[Condensation]

I hope everyone is well and I wish you all a happy and healthy new year !

I was hoping to push back my regular Rituximab infusion to give Omicron a chance to calm down.

But the results of the latest blood test force me now to have it quite soon. I was also due my fourth vaccine.

Does anyone know what the usual protocol is ? Last time I think ,I had the vaccine first and then two weeks later the third vaccine.

Any experience?

Many thanks

[vivdunstan Volunteer]

I think this is something you really need to talk to your consultant(s) about, urgently. Even by phone will do.

However the British Society for Rheumatology does give some guidelines. Specifically from rheumatology.org.uk/practic...

" If a patient is offered a date for vaccination, vaccinate and delay rituximab for four weeks where clinically appropriate

If vaccine is available now for the patient but patient is still B-cell depleted on rituximab, do not delay vaccination until B-cells recover but vaccinate now. There is no evidence to suggest how long after rituximab a patient should delay vaccination with a COVID-19 vaccine, but consensus suggests this should ideally be 4-8 weeks after rituximab if it is ok to defer a COVID-19 vaccine. This decision may depend upon the prevalence of COVID-19. A shared decision should be made with the patient

If vaccine isn't available now for the patient, and it’s not safe to delay rituximab for four weeks because of organ or life-threatening disease, give rituximab without delay and vaccinate whenever a vaccine is subsequently available

If a vaccine isn't available now, and it is safe to delay rituximab or to switch to an alternative treatment, consider these options. A shared decision should be made with the patient"

Sadly Rituximab does affect the vaccine response, so it is important to time things in as optimal a way as possible. But that isn't always feasible.

But again you really need to talk to your consultant about this. ASAP.

Best wishes.

[Red-head44 in reply to vivdunstan]

Agree

[Investigator1]

Hi Condensation. My consultant (I am on Rituximab) told me a minimum of 2 weeks to have vaccine prior to infusion (I was 4 weeks) and a minimum of 2 months to have vaccine after Rituximab which sort of adheres to the 3 month rule for next jab.

[Starray]

Hi, I had a bad reaction to my 3rd vaccine and it looks like it brought on a flare. I had it 2 weeks before Rituximab when my b-cells were growing back. This time I’ve been advised to have it not later than @6 weeks before my next Rituximab so that my b-cells are not fully grown back and I don’t react as severely. I’ve still been told to have it though. Obviously, all of this might not apply to you.

[DazVin]

TBH I don't think there is ANY protocol they are just making it up as they go along! I was due my annual maintenance Rituximab last August, had my bloods as per normal a week or so before then they called me 4 days before I was due to have it saying that they thought it best that I wait for a 3rd vaccine as the 1st 2 had done nothing for me.......I said I didn't want a 3rd one then as in my opinion it was worthless - and that another relapse from GPA was my main concern! this fell on deaf ears and they would not listen to me so they cancelled Rituximab. Against my wishes I had 3rd jab end of September then had to wait 4 weeks to get my Rituximab at the end of October. Bearing in mind that I have more or less been isolating for the past 18 months and only going out if necessary, always when quiet though and always wear a mask and sanitize etc. Christmas day felt unwell, had a poor nights sleep so did a lateral flow test Boxing day and you guessed it - positive for Covid! PCR test the following day confirmed so made to isolate for 10 days lol, during this time I was quite anxious - tried all avenues to see if I could get the mystical anti virals to no avail! finally got a call back from hospital from a nurse who couldn't help apart from suggest I do an online survey for the PANORAMIC trial team so did this and got a call back saying I definitely ticked all the boxes so was able to be entered into the lottery to see if I could get the anti viral.....computer said NO lol but would I mind filling in an online diary every day? I have done this but I am honestly losing all faith in all this. And it gets better......they now want me to book for a 4th jab! wonder what crap they will inject this time?