A Narrative Review on The Effect of Rituximab on Secondary Humoral Immune Response
Abstract
Rituximab is a chimeric monoclonal antibody with binding specificity to CD20-positive B lymphocytes. Patients administered rituximab would not have adequate humoral response to the SARS-CoV-2 vaccine. Rituximab can also affect the durability of immunization. Plasma-secreting antibodies and memory B-cells are two major arms of long-term immunity. The role of memory B-cells becomes prominent by decreasing antibody titers over time. The activated memory B cells have CD20 protein on their surface. Investigating the effect of rituximab on other vaccines has demonstrated attenuated recall response. The evidence in this review suggests that we can also expect a deficit of recall response to SARS-CoV-2, making the rituximab-treated patients susceptible to reinfection with emerging variants. Therefore, it is better to consider other therapeutic options, use lower rituximab doses, and employ booster vaccines at shorter intervals.
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7. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-36.
8. Kridin K, Schonmann Y, Weinstein O, Schmidt E, Ludwig RJCohen AD. The risk of COVID-19 in patients with bullous pemphigoid and pemphigus: A population-based cohort study. J Am Acad Dermatol. 2021;85(1):79-87.
9. Cragg MS, Walshe CA, Ivanov AOGlennie MJ. The biology of CD20 and its potential as a target for mAb therapy. Curr Dir Autoimmun. 2005;8:140-74.
10. Shanehbandi D, Majidi J, Kazemi T, Baradaran BAghebati-Maleki L. CD20-based Immunotherapy of B-cell Derived Hematologic Malignancies. Curr Cancer Drug Targets. 2017;17(5):423-44.
11. Lee DSW, Rojas OLGommerman JL. B cell depletion therapies in autoimmune disease: advances and mechanistic insights. Nature Reviews Drug Discovery. 2021;20(3):179-99.
12. Strangfeld A, Schäfer M, Gianfrancesco MA, Lawson-Tovey S, Liew JW, Ljung L, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2021;80(7):930-42.
13. Andersen KM, Bates BA, Rashidi ES, Olex AL, Mannon RB, Patel RC, et al. Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative. Lancet Rheumatol. 2022;4(1):e33-e41.
14. Simpson-Yap S, De Brouwer E, Kalincik T, Rijke N, Hillert JA, Walton C, et al. Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis. Neurology. 2021;97(19):e1870-e85.
15. Boekel LWolbink GJ. Rituximab during the COVID-19 pandemic: time to discuss treatment options with patients. The Lancet Rheumatology. 2022;4(3):e154-e55.
16. Langer-Gould A, Smith JBLi BH. Multiple sclerosis, rituximab, and COVID-19. Ann Clin Transl Neurol. 2021;8(4):938-43.
17. Sparks JA, Wallace ZS, Seet AM, Gianfrancesco MA, Izadi Z, Hyrich KL, et al. Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry. Ann Rheum Dis. 2021;80(9):1137-46.
18. Mahmoudi H, Farid AS, Nili A, Dayani D, Tavakolpour S, Soori T, et al. Characteristics and outcomes of COVID-19 in patients with autoimmune bullous diseases: A retrospective cohort study. J Am Acad Dermatol. 2021;84(4):1098-100.
19. Joly P. Incidence and severity of COVID-19 in patients with autoimmune blistering skin diseases: A nationwide study. J Am Acad Dermatol. 2022;86(2):494-97.
20. Shakshouk H, Daneshpazhooh M, Murrell DFLehman JS. Treatment considerations for patients with pemphigus during the COVID-19 pandemic. J Am Acad Dermatol. 2020;82(6):e235-e36.
21. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-15.
22. Eyre DW, Lumley SF, Wei J, Cox S, James T, Justice A, et al. Quantitative SARS-CoV-2 anti-spike responses to Pfizer-BioNTech and Oxford-AstraZeneca vaccines by previous infection status. Clin Microbiol Infect. 2021;27(10):1516.e7-16.e14.
23. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5):403-16.
24. Kroon FPB, Najm A, Alunno A, Schoones JW, Landewé RBM, Machado PM, et al. Risk and prognosis of SARS-CoV-2 infection and vaccination against SARS-CoV-2 in rheumatic and musculoskeletal diseases: a systematic literature review to inform EULAR recommendations. Ann Rheum Dis. 2022;81(3):422-32.
25. Jena A, Mishra S, Deepak P, Kumar MP, Sharma A, Patel YI, et al. Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: Systematic review and meta-analysis. Autoimmun Rev. 2022;21(1):102927.
26. Mrak D, Tobudic S, Koblischke M, Graninger M, Radner H, Sieghart D, et al. SARS-CoV-2 vaccination in rituximab-treated patients: B cells promote humoral immune responses in the presence of T-cell-mediated immunity. Ann Rheum Dis. 2021;80(10):1345-50.
27. Ferretti F, Cannatelli R, Benucci M, Carmagnola S, Clementi E, Danelli P, et al. How to Manage COVID-19 Vaccination in Immune-Mediated Inflammatory Diseases: An Expert Opinion by IMIDs Study Group. Front Immunol. 2021;12:656362.
28. Dan JM, Mateus J, Kato Y, Hastie KM, Yu ED, Faliti CE, et al. Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection. Science. 2021;371(6529).
29. Isho B, Abe KT, Zuo M, Jamal AJ, Rathod B, Wang JH, et al. Persistence of serum and saliva antibody responses to SARS-CoV-2 spike antigens in COVID-19 patients. Sci Immunol. 2020;5(52).
30. Seow J, Graham C, Merrick B, Acors S, Pickering S, Steel KJA, et al. Longitudinal observation and decline of neutralizing antibody responses in the three months following SARS-CoV-2 infection in humans. Nat Microbiol. 2020;5(12):1598-607.
31. de Mattos Barbosa MG, Liu H, Huynh D, Shelley G, Keller ET, Emmer BT, et al. IgV somatic mutation of human anti-SARS-CoV-2 monoclonal antibodies governs neutralization and breadth of reactivity. JCI Insight. 2021;6(9).
32. Goel RR, Apostolidis SA, Painter MM, Mathew D, Pattekar A, Kuthuru O, et al. Distinct antibody and memory B cell responses in SARS-CoV-2 naïve and recovered individuals following mRNA vaccination. Sci Immunol. 2021;6(58).
33. Mesin L, Schiepers A, Ersching J, Barbulescu A, Cavazzoni CB, Angelini A, et al. Restricted Clonality and Limited Germinal Center Reentry Characterize Memory B Cell Reactivation by Boosting. Cell. 2020;180(1):92-106.e11.
34. Tay MZ, Rouers A, Fong SW, Goh YS, Chan YH, Chang ZW, et al. Decreased memory B cell frequencies in COVID-19 delta variant vaccine breakthrough infection. EMBO Mol Med. 2022;14(3):e15227.
35. Klein U, Rajewsky KKüppers R. Human immunoglobulin (Ig)M+IgD+ peripheral blood B cells expressing the CD27 cell surface antigen carry somatically mutated variable region genes: CD27 as a general marker for somatically mutated (memory) B cells. J Exp Med. 1998;188(9):1679-89.
36. Wu YC, Kipling DDunn-Walters DK. The relationship between CD27 negative and positive B cell populations in human peripheral blood. Front Immunol. 2011;2:81.
37. Seifert MKüppers R. Human memory B cells. Leukemia. 2016;30(12):2283-92.
38. Palm AEHenry C. Remembrance of Things Past: Long-Term B Cell Memory After Infection and Vaccination. Front Immunol. 2019;10:1787.
39. Sellam J, Rouanet S, Hendel-Chavez H, Abbed K, Sibilia J, Tebib J, et al. Blood memory B cells are disturbed and predict the response to rituximab in patients with rheumatoid arthritis. Arthritis Rheum. 2011;63(12):3692-701.
40. Popa C, Leandro MJ, Cambridge GEdwards JC. Repeated B lymphocyte depletion with rituximab in rheumatoid arthritis over 7 yrs. Rheumatology (Oxford). 2007;46(4):626-30.
41. Nishio M, Fujimoto K, Yamamoto S, Endo T, Sakai T, Obara M, et al. Delayed redistribution of CD27, CD40 and CD80 positive B cells and the impaired in vitro immunoglobulin production in patients with non-Hodgkin lymphoma after rituximab treatment as an adjuvant to autologous stem cell transplantation. Br J Haematol. 2007;137(4):349-54.
42. Leandro MJ, Cambridge G, Ehrenstein MREdwards JC. Reconstitution of peripheral blood B cells after depletion with rituximab in patients with rheumatoid arthritis. Arthritis Rheum. 2006;54(2):613-20.
43. Maurer MA, Rakocevic G, Leung CS, Quast I, Lukačišin M, Goebels N, et al. Rituximab induces sustained reduction of pathogenic B cells in patients with peripheral nervous system autoimmunity. The Journal of clinical investigation. 2012;122(4):1393-402.
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| Files | ||
| Issue | Vol 7, No 4 (2024) | |
| Section | Review Article | |
| DOI | https://doi.org/10.18502/igj.v7i4.17887 | |
| Keywords | ||
| SARS-CoV-2 COVID-19 Rituximab Vaccination | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Dasdar S, Kianfar N, Mahmoudi H, Daneshpazhooh M. A Narrative Review on The Effect of Rituximab on Secondary Humoral Immune Response. Immunol Genet J. 2024;7(4):213-219.
