Rituximab-treated patients have a poor response to influenza vaccination.
The efficacy of influenza vaccination in patients treated with rituximab is a clinically important question. Rheumatology clinics are populated with patients receiving rituximab for a broad array of disorders. Although several studies have explored the efficacy of other vaccines in rituximab-treated populations, results have been conflicting. We wished to define influenza vaccine efficacy in a rituximab-treated cohort. We examined 17 evaluable subjects treated with rituximab for rheumatologic conditions. T cell subsets, B cells subsets, T cell function, and B cell function were evaluated at specific time points along with hemagglutinination inhibition titers after receiving the standard inactivated influenza vaccine. T cell subset counts were significantly different than controls but did not change with rituximab. B cells depleted in all patients but were in various stages of recovery at the time of vaccination. Influenza vaccine responsiveness was poor overall, with only 16 % of subjects having a four-fold increase in titer. Pre-existing titers were retained throughout the study, however. The ability to respond to the influenza vaccine appeared to be related to the degree of B cell recovery at the time of vaccination. This study emphasizes that antibody responses to vaccine are impaired in subjects treated with rituximab and supports the concept that B cell recovery influences influenza vaccine responsiveness.
Division of Rheumatology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Robert A
RA
Eisenberg
Abbas F
AF
Jawad
Jean
J
Boyer
Kelly
K
Maurer
Kenyetta
K
McDonald
Eline T Luning
ET
Prak
Kathleen E
KE
Sullivan
D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects* / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000276:immunology; D018941:Antigens, CD19 / Q000378:metabolism; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D005260:Female; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D007074:Immunoglobulin G / Q000276:immunology; D007156:Immunologic Memory; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D018655:Lymphocyte Count; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000276:immunology*; D000069283:Rituximab; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism
D058846:Antibodies, Monoclonal, Murine-Derived; D000914:Antibodies, Viral; D018941:Antigens, CD19; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007252:Influenza Vaccines; D000069283:Rituximab