Sustained cell-mediated but not humoral responses in rituximab-treated rheumatic patients after vaccination against SARS-CoV-2
Authors' conclusion
Four out of ten RTX-treated vaccinated patients show lasting cell-mediated immune response despite undetectable anti-spike antibodies. Cumulative RTX dose affects both humoral and cell-mediated responses to SARS-CoV-2 vaccines.
Study context
- Population
- Rituximab (RTX)-treated rheumatic patients 3–6 months after last SARS-CoV-2 vaccination
- Participants
- 60 patients
- Outcome
- Humoral (anti-spike SARS-CoV-2 IgG by ELISA) and cell-mediated (Covi-FERON interferon-γ release assay) immune response after SARS-CoV-2 vaccination
- Follow-up
- 3-6 months after last vaccination
Methodological details3-month follow-up for breakthrough infection
- 3-month follow-up for breakthrough infection
Main finding
As reported in the abstract
Positive Covi-FERON (cell mediated (CMI) response)
40
66.7%
Detectable anti-spike IgG
23
38.3%
Positive only for Covi-FERON
37%
Positive only for anti-spike IgG
7%
Observational data: associations, not effects.
Further findings
Covi-FERON positive vs Covi-FERON negative
Median RTX cumulative dose, Covi-FERON positive vs negative
P = 0.019
Anti-spike IgG positive vs Anti-spike IgG negative
RTX cumulative dose, anti-spike IgG positive vs negative
P = 0.002
Time from last vaccination to sampling, anti-spike IgG positive vs negative
P = 0.047
| Outcome | Anti-spike IgG positive | Anti-spike IgG negative | P value |
|---|---|---|---|
| RTX cycles, anti-spike IgG positive vs negative | 2 (IQR 2–4) | 6 (IQR 4–8) | P = 0.002 |
BTI vs No BTI
| Outcome | BTI | No BTI | P value |
|---|---|---|---|
| CMI response against Delta variant, BTI vs no BTI | 25% | 55% | P = 0.03 |
Breakthrough COVID-19 infection (BTI) post sampling · 3 months post sampling
- BTI, exclusively during Omicron variant predominance
- 20 (33.3%)
Original publication
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