Covid Vaccine After Rituximab - Timimg

[Investigator1]

I must admit I am at a bit of a loss on this one due to the conflicting information I am getting. I had my last Rituximab in November and I have been offered another Covid Jab. Now I know the NHS system isn’t complexed enough to deduce timings however I have heard so many different timescales that determine how long after Rituximab I can have the Covid Vaccine. I have been told 1 month, 2 months, 3 months and 6 months. I had my last Covid Jab at the end of August. I see my Consultant on 6th Jan but I would welcome any experiences or information on this. In the past I have had the vaccine a month after Rituximab. Thanks all in advance. Nick.

[Muse101]

I am almost sure it is a month after the Rituximab infusion. I remember being asked to go for mine and I am sure they (consultants secretary) told me I needed to wait a month. The best thing to do is phone the consultants secretary (as I did) and ask them they will tell you straight away how long it needs to be. I am with a consultant at the Royal Infirmary Edinburgh. I hope this is of some use to you. Keep well.

[Investigator1 in reply to Muse101]

thanks Muse 101, that’s really useful.

[SandieB in reply to Muse101]

I was told 1 month before or 1 month after i actually waited 6 weeks after the Retuximab and i was fine no problems at all.

[Investigator1 in reply to SandieB]

brilliant! I will talk to the pharmacy, trying to get hold of the Renal Secretaries is difficult. But thanks for getting back to me. Nick.

[SandieB]

You are very welcome. Have a lovely Christmas and best wishes for 2023🎅🌲🎅

[Boffy08]

hi, I was told 6 months after. I had my last Rituximab on the 1st September. Saying that, last time i had a covid jab 10 months after rituximab and still didn’t make any antibodies!!

[Hidden]

hi nick, I’ve had two fusions of rituximab in august, I stay away from covid jabs now, the last 3 have given me illness, the latest is chronic rhino sinusitis,7 months of torture so far. No more covid jabs for me, nobody knows what’s in them mate. I know there’s illness in them for immunocomprimised patients. Rituximab is way better than cyclophosphamide. Good luck with your jabs mate. Stay well. 👍🏼

[Investigator1 in reply to Hidden]

Thanks Johnyboy66 and to everybody who has helped. I had an antibody test 6 weeks after my second jab in April 2021 and although the line was faint, after I had sent the results to the lab they showed I had built up some antibodies. On my original question about how long after Rituximab, I contacted the Pharmacist who said “anytime after a month” providing my Consultants team authorised it. I rang them and got a definitive “minimum of 6 weeks” so I am booked in for the 28th of December. Thanks again all. Nick.

[GPAC]

This is great question and I am not sure anyone has a really good answer. I thought traditional thinking would say the further away from the RTX infusion the better the vaccine uptake and the better the COVID antibody production, but I am not sure there is any evidence to support this either way! Maybe someone has tested this with COVID titer results over time? I think, if you have no B cells then generating any response from any vaccine will not be ideal. To address this problem AstraZeneca developed Evusheld which gives you most of the antibodies to protect you against most of the COVID variants out there. Getting Evusheld, in addition to the COVID vaccines, at spaced out intervals, seems to be the best approach and COVID protection for B cell depleted ANCA patients. Can you get Evusheld in the UK, or is it restricted use only, or is not approved for use? In Canada and the USA it is being used in many jurisdictions.

[Investigator1 in reply to GPAC]

Hi GPCA, yes Evusheild is available but not on our NHS, it is approved by the UK Drug Agency but you have to pay, with consultations etc it costs about £2K ($2300) which lasts about 6 months. I do have antibodies, whether they ate T cells or from the vaccine I don’t know and don’t really care as long as I have got some. I have had 6 shots of the vaccine and I am due my 7th on the 28th.

[GPAC in reply to Investigator1]

That's really unfortunate the NHS does not cover Evusheld for B cell depleted patients. Maybe a letter writing campaign to the NHS and your minister of health would help? Is Evusheld covered for any patients? It should be covered to many cancer and transplant patients! I also think Evusheld 2.0 is expected before long and this will be even more finally tuned to the top circulating COVID variants now, and those that may have escaped the current version of Evusheld. Perhaps the NHS will reconsider for Evusheld 2.0 as it is known that B cell depleted patients will at best only have a blunted vaccine response. Time to pressure the NHS and your politicians!

[Investigator1 in reply to GPAC]

Evusheild isn’t available to anybody for free as yet, petitions have been made, campaigners have done tireless work and it’s been raised several times in parliament, we are all doing our bit over here however the Government are just saying “we are still watching the data” many of us feel there is an issue that the government has with Astra Zeneca. It’s well advanced over here and those of us who are CEV are well briefed but frustrated. As far as catching Covid, we do get treatment on the NHS, I got Monoclonal Antibody treatment Sotrovimab that is administered in the first 2+5 days of minor symptoms, if patients deteriorate they get Anti Viral treatment.

Our NHS is in turmoil at the moment with Ambulance waiting times the longest ever, patient care time limits extending and hospital beds reducing, there are nearly 200,000 vacancies in the NHS and Nurses are currently on 1-day strikes. Having said that nearly all our treatment and care is free and when I contracted GPA my treatment (free) has been first class. My opinion is the NHS is a bit broken but will get it right and it is a better option than that adopted in the US, a lot of people over here just couldn’t simply afford it.

[GPAC]

In your situation, which is not uncommon, It would seem prudent to get access to Paxlovid if you did test positive to COVID. However, if you have impaired kidney function measured by eGFR testing, you may need to adjust the dose down as Paxlovid requires normal eGFR to be optimal, and you have 5 days since COVID onset to start Paxlovid for it to be optimal against COVID! Might be a good idea to have access to Paxlovid approved in advance especially if you have reduced lung function and other risk factors for a poor COVID outcome!

[HullBoy]

Hi, I had my second Rituximab infusion at the end of May 2022 and my Covid booster and Flu jabs simultaneously in October 2022, with no issues. My Renal consultant was keen for me to get the vaccinations ASAP ( from August onwards) From what I understood there was no time limit set from when I had the Rituximab, it was just down to the availability of the Covid and Flu vaccines. I also was told that the vaccines were safe to use in my situation because they weren't "live" vaccines. Certainly I suffered no ill effects and no different reaction to the vaccines compared to my" pre vasculitis/ Rituximab" days

Hope this helps

[Investigator1 in reply to HullBoy]

Hi Hullboy, yes my previous 6 vaccinations have only produced a bit of tiredness and a flu-like feeling for a few hours but well worth it.. I was told having a vaccination while Rituximab was in Full Flow (2-6 weeks) May reduce some of the vaccine effectiveness.