Rituximab-treated patients have a poor response to influenza vaccination

J Clin Immunol. 2013 Feb;33(2):388-96. doi: 10.1007/s10875-012-9813-x. Epub 2012 Oct 14.

Abstract

The efficacy of influenza vaccination in patients treated with rituximab is a clinically important question. Rheumatology clinics are populated with patients receiving rituximab for a broad array of disorders. Although several studies have explored the efficacy of other vaccines in rituximab-treated populations, results have been conflicting. We wished to define influenza vaccine efficacy in a rituximab-treated cohort. We examined 17 evaluable subjects treated with rituximab for rheumatologic conditions. T cell subsets, B cells subsets, T cell function, and B cell function were evaluated at specific time points along with hemagglutinination inhibition titers after receiving the standard inactivated influenza vaccine. T cell subset counts were significantly different than controls but did not change with rituximab. B cells depleted in all patients but were in various stages of recovery at the time of vaccination. Influenza vaccine responsiveness was poor overall, with only 16 % of subjects having a four-fold increase in titer. Pre-existing titers were retained throughout the study, however. The ability to respond to the influenza vaccine appeared to be related to the degree of B cell recovery at the time of vaccination. This study emphasizes that antibody responses to vaccine are impaired in subjects treated with rituximab and supports the concept that B cell recovery influences influenza vaccine responsiveness.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal, Murine-Derived / adverse effects*
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antibodies, Viral / immunology
  • Antigens, CD19 / metabolism
  • Antirheumatic Agents / adverse effects*
  • Antirheumatic Agents / therapeutic use
  • B-Lymphocytes / drug effects
  • B-Lymphocytes / immunology
  • B-Lymphocytes / metabolism
  • Female
  • Humans
  • Immunity, Humoral / drug effects*
  • Immunoglobulin G / immunology
  • Immunologic Memory
  • Influenza Vaccines / administration & dosage
  • Influenza Vaccines / immunology*
  • Influenza, Human / prevention & control*
  • Lymphocyte Count
  • Lymphocyte Depletion
  • Male
  • Middle Aged
  • Rheumatic Diseases / drug therapy
  • Rheumatic Diseases / immunology*
  • Rituximab
  • T-Lymphocyte Subsets / immunology
  • T-Lymphocyte Subsets / metabolism

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Antibodies, Viral
  • Antigens, CD19
  • Antirheumatic Agents
  • Immunoglobulin G
  • Influenza Vaccines
  • Rituximab