Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patients
BackgroundBy depleting circulating B lymphocytes, rituximab time-dependently suppresses coronavirus disease 2019 (COVID-19) vaccines’ humoral immunogenicity for a prolonged period. The optimal time to vaccinate rituximab-exposed immune-mediated dermatologic disease (IMDD) patients is currently uncle...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-03-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1138765/full |
| _version_ | 1797870464507314176 |
|---|---|
| author | Chutima Seree-aphinan Yanisa Ratanapokasatit Poonkiat Suchonwanit Ploysyne Rattanakaemakorn Pichaya O-Charoen Prapaporn Pisitkun Thanitta Suangtamai Chavachol Setthaudom Sonphet Chirasuthat Kumutnart Chanprapaph |
| author_facet | Chutima Seree-aphinan Yanisa Ratanapokasatit Poonkiat Suchonwanit Ploysyne Rattanakaemakorn Pichaya O-Charoen Prapaporn Pisitkun Thanitta Suangtamai Chavachol Setthaudom Sonphet Chirasuthat Kumutnart Chanprapaph |
| author_sort | Chutima Seree-aphinan |
| collection | DOAJ |
| description | BackgroundBy depleting circulating B lymphocytes, rituximab time-dependently suppresses coronavirus disease 2019 (COVID-19) vaccines’ humoral immunogenicity for a prolonged period. The optimal time to vaccinate rituximab-exposed immune-mediated dermatologic disease (IMDD) patients is currently unclear.ObjectiveTo estimate the vaccination timeframe that equalized the occurrence of humoral immunogenicity outcomes between rituximab-exposed and rituximab-naïve IMDD patients.MethodsThis retrospective cohort study recruited rituximab-exposed and age-matched rituximab-naïve subjects tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunity post-vaccination. Baseline clinical and immunological data (i.e., immunoglobulin levels, lymphocyte immunophenotyping) and SARS-CoV-2-specific immunity levels were extracted. The outcomes compared were the percentages of subjects who produced neutralizing antibodies (seroconversion rates, SR) and SARS-CoV-2-specific IgG levels among seroconverters. The outcomes were first analyzed using multiple regressions adjusted for the effects of corticosteroid use, steroid-spearing agents, and pre-vaccination immunological status (i.e., IgM levels, the percentages of the total, naïve, and memory B lymphocytes) to identify rituximab-related immunogenicity outcomes. The rituximab-related outcome differences with a 95% confidence interval (CI) between groups were calculated, starting by including every subject and then narrowing down to those with longer rituximab-to-vaccination intervals (≥3, ≥6, ≥9, ≥12 months). The desirable cut-off performances were <25% outcome inferiority observed among rituximab-exposed subgroups compared to rituximab-naïve subjects, and the positive likelihood ratio (LR+) for the corresponding outcomes ≥2.FindingsForty-five rituximab-exposed and 90 rituximab-naive subjects were included. The regression analysis demonstrated a negative association between rituximab exposure status and SR but not with SARS-CoV-2-specific IgG levels. Nine-month rituximab-to-vaccination cut-off fulfilled our prespecified diagnostic performance (SR difference between rituximab-exposed and rituximab-naïve group [95%CI]: -2.6 [-23.3, 18.1], LR+: 2.6) and coincided with the repopulation of naïve B lymphocytes in these patients.ConclusionsNine months of rituximab-to-vaccination interval maximize the immunological benefits of COVID-19 vaccines while avoiding unnecessary delay in vaccination and rituximab treatment for IMDD patients. |
| first_indexed | 2024-04-10T00:28:56Z |
| format | Article |
| id | doaj.art-93993bfceaca4943bd2263e4dd6676f4 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-10T00:28:56Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-93993bfceaca4943bd2263e4dd6676f42023-03-15T05:14:59ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-03-011410.3389/fimmu.2023.11387651138765Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patientsChutima Seree-aphinan0Yanisa Ratanapokasatit1Poonkiat Suchonwanit2Ploysyne Rattanakaemakorn3Pichaya O-Charoen4Prapaporn Pisitkun5Thanitta Suangtamai6Chavachol Setthaudom7Sonphet Chirasuthat8Kumutnart Chanprapaph9Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDivision of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDivision of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDivision of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDivision of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, ThailandDivision of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, ThailandDivision of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, ThailandImmunology Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDivision of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDivision of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandBackgroundBy depleting circulating B lymphocytes, rituximab time-dependently suppresses coronavirus disease 2019 (COVID-19) vaccines’ humoral immunogenicity for a prolonged period. The optimal time to vaccinate rituximab-exposed immune-mediated dermatologic disease (IMDD) patients is currently unclear.ObjectiveTo estimate the vaccination timeframe that equalized the occurrence of humoral immunogenicity outcomes between rituximab-exposed and rituximab-naïve IMDD patients.MethodsThis retrospective cohort study recruited rituximab-exposed and age-matched rituximab-naïve subjects tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunity post-vaccination. Baseline clinical and immunological data (i.e., immunoglobulin levels, lymphocyte immunophenotyping) and SARS-CoV-2-specific immunity levels were extracted. The outcomes compared were the percentages of subjects who produced neutralizing antibodies (seroconversion rates, SR) and SARS-CoV-2-specific IgG levels among seroconverters. The outcomes were first analyzed using multiple regressions adjusted for the effects of corticosteroid use, steroid-spearing agents, and pre-vaccination immunological status (i.e., IgM levels, the percentages of the total, naïve, and memory B lymphocytes) to identify rituximab-related immunogenicity outcomes. The rituximab-related outcome differences with a 95% confidence interval (CI) between groups were calculated, starting by including every subject and then narrowing down to those with longer rituximab-to-vaccination intervals (≥3, ≥6, ≥9, ≥12 months). The desirable cut-off performances were <25% outcome inferiority observed among rituximab-exposed subgroups compared to rituximab-naïve subjects, and the positive likelihood ratio (LR+) for the corresponding outcomes ≥2.FindingsForty-five rituximab-exposed and 90 rituximab-naive subjects were included. The regression analysis demonstrated a negative association between rituximab exposure status and SR but not with SARS-CoV-2-specific IgG levels. Nine-month rituximab-to-vaccination cut-off fulfilled our prespecified diagnostic performance (SR difference between rituximab-exposed and rituximab-naïve group [95%CI]: -2.6 [-23.3, 18.1], LR+: 2.6) and coincided with the repopulation of naïve B lymphocytes in these patients.ConclusionsNine months of rituximab-to-vaccination interval maximize the immunological benefits of COVID-19 vaccines while avoiding unnecessary delay in vaccination and rituximab treatment for IMDD patients.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1138765/fullrituximabanti-CD20 antibodyvaccinesCOVID-19 vaccinesimmunogenicityimmune-mediated dermatologic diseases |
| spellingShingle | Chutima Seree-aphinan Yanisa Ratanapokasatit Poonkiat Suchonwanit Ploysyne Rattanakaemakorn Pichaya O-Charoen Prapaporn Pisitkun Thanitta Suangtamai Chavachol Setthaudom Sonphet Chirasuthat Kumutnart Chanprapaph Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patients Frontiers in Immunology rituximab anti-CD20 antibody vaccines COVID-19 vaccines immunogenicity immune-mediated dermatologic diseases |
| title | Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patients |
| title_full | Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patients |
| title_fullStr | Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patients |
| title_full_unstemmed | Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patients |
| title_short | Optimal time for COVID-19 vaccination in rituximab-treated dermatologic patients |
| title_sort | optimal time for covid 19 vaccination in rituximab treated dermatologic patients |
| topic | rituximab anti-CD20 antibody vaccines COVID-19 vaccines immunogenicity immune-mediated dermatologic diseases |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1138765/full |
| work_keys_str_mv | AT chutimasereeaphinan optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT yanisaratanapokasatit optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT poonkiatsuchonwanit optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT ploysynerattanakaemakorn optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT pichayaocharoen optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT prapapornpisitkun optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT thanittasuangtamai optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT chavacholsetthaudom optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT sonphetchirasuthat optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients AT kumutnartchanprapaph optimaltimeforcovid19vaccinationinrituximabtreateddermatologicpatients |