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Vaccination before rituximab — SCE Rheumatology MCQ

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HardRheumatoid arthritisVaccination before rituximabSCE Rheumatology

A 59-year-old woman with RA is due to start rituximab after inadequate response to a TNF inhibitor. She has never received pneumococcal vaccination and is also due a shingles vaccine. FBC, LFTs and renal function are satisfactory. What is the most appropriate management before rituximab?

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Correct answer: B — Update indicated non-live vaccines before B-cell depletion where feasible

Vaccination response is reduced after rituximab, so indicated non-live vaccines should be given before B-cell depletion where possible. Live vaccines are generally avoided during significant immunosuppression and require careful timing. The key principle is to optimise vaccine protection before biologic therapy rather than waiting until responses are impaired.

Reference: BSR biologic DMARD safety guideline; Green Book immunisation guidance