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Rituximab Vaccine Response COVID — ESENeph MCQ

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ModerateRenal VasculitisRituximab Vaccine Response COVIDESENeph

A 55-year-old man with ANCA vasculitis in remission on Rituximab develops severe COVID-19. He had been vaccinated but had undetectable anti-spike antibodies. What predicts poor vaccine response in Rituximab-treated patients?

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Correct answer: C — B-cell depletion from Rituximab impairs humoral (antibody) vaccine response; vaccination should ideally be timed >6 months after last Rituximab dose and >4 weeks before the next dose to maximise response

Rituximab-induced B-cell depletion profoundly impairs humoral (antibody) vaccine responses. Anti-spike antibody seroconversion rates after COVID-19 vaccination are <50% in Rituximab-treated patients vs >90% in the general population. Optimal timing: vaccinate >6 months after last Rituximab when B-cells are recovering (check CD19 count), and >4 weeks before the next planned dose. T-cell responses are partially preserved (providing some protection). Additional booster doses, tixagevimab/cilgavimab (Evusheld) prophylaxis (when available), and early antiviral treatment if infected are important strategies.

Reference: BSR 2023 – Vaccination in Rituximab; UKKA 2023 – COVID