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Rituximab Vaccination Timing — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyRituximab Vaccination TimingSCE Rheumatology

A 60-year-old woman with RA has achieved sustained remission on Methotrexate 15 mg weekly and Rituximab (last infusion 8 months ago). She is now due for her annual influenza vaccine. What consideration applies to vaccination timing with Rituximab?

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Correct answer: D — Rituximab causes prolonged B-cell depletion and vaccines should ideally be given at least 6 months after Rituximab infusion (when B-cell recovery begins) and at least 4 weeks before the next planned infusion to maximise vaccine immunogenicity

Rituximab causes prolonged B-cell depletion (nadir at 2-6 months partial recovery at 6-12 months). Vaccine responses are significantly impaired during B-cell depletion. BSR biologic safety guidelines and EULAR recommendations advise timing vaccines at least 6 months after Rituximab (when B cells begin to repopulate) and at least 4 weeks before the next scheduled infusion. If this timing is not possible the vaccine should still be given (some T-cell-dependent response may occur) but response is likely suboptimal. Checking peripheral B-cell counts (CD19) can help guide optimal vaccination timing. This applies to all inactivated vaccines.

Reference: BSR 2019 biologic safety guidelines; EULAR 2019 vaccination recommendations