Rituximab-treated patients have a poor response to influenza vaccination
Open accessAbstract
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.
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For rheumatoid arthritis patients on rituximab, the amount of B-cell recovery when vaccinated is linked to the strength of the humoral response, a pattern also seen with influenza vaccine.
“The degree of B-cell recovery at the time of vaccination correlated with the extent of the humoral response to vaccination, as reported for influenza vaccine in patients with RA treated with rituximab.38”
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- Authors
- Eisenberg, R. A., Jawad, A. F., Boyer, J., Maurer, K., McDonald, K., Prak, E. T. L., & Sullivan, K. E.
- Affiliations
- University of Pennsylvania (US)
- Children's Hospital of Philadelphia (US)
- Abramson Cancer Center (US)
- Corresponding author
- Sullivan, Kathleen E
- Venue
- Journal of Clinical Immunology
- Published
- 2012-10-14
- Volume
- 33
- Issue
- 2
- Pages
- 388-396
- ISSN
- 0271-9142 (ISSN-L)
- 1573-2592
- PMC
- PMC3565069
- OpenAlex
- W1977749342
- Cited by
- 126
- References
- 63
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 3 · 2023: 11 · 2022: 20 · 2021: 31 · 2020: 8 · 2019: 3 · 2018: 3 · 2017: 7 · 2016: 10 · 2015: 5 · 2014: 7 · 2013: 7
- FWCI
- 4.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01ai50024-7-0-1)
- National Cancer Institute (P30CA016520)
- National Institute of Allergy and Infectious Diseases (N01-AI-50024, R01AI063626, N01 AI050024)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR034156)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
- Keywords
- rituximab, influenza vaccination, vaccine response, B-cell depletion, B cell recovery, T cell subsets, humoral immunity, rheumatic diseases, hemagglutination inhibition, antibody response
- MeSH terms
- Rituximab, Adult, Aged, Antibodies, Viral, B-Lymphocytes, Female, Humans, Immunoglobulin G, Immunologic Memory, Influenza, Human, Influenza Vaccines, Lymphocyte Depletion, Male, Middle Aged, Rheumatic Diseases, T-Lymphocyte Subsets, Antirheumatic Agents, Lymphocyte Count, Antigens, CD19, Immunity, Humoral, Antibodies, Monoclonal, Murine-Derived
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