Rituximab impairs immunoglobulin (Ig)M and IgG (subclass) responses after influenza vaccination in rheumatoid arthritis patients
Open accessAbstract
Summary: Rituximab (RTX) treatment in rheumatoid arthritis (RA) patients severely hampers humoral response after influenza vaccination as determined by haemagglutination inhibition assay (HI). It is not known whether HI reflects both immunoglobulin (Ig)M and IgG (subclass) influenza response, and whether IgM antibodies contribute to the low rate of influenza infection seen in RA patients. Twenty RA patients on methotrexate (MTX), 23 on RTX and 28 healthy controls (HC) received trivalent influenza subunit vaccination. Before and 28 days after vaccination, H1N1- and H3N2-specific antibodies were measured by HI and by IgM and IgG (subclass) enzyme-linked immunosorbent assay (ELISA). B cell activating factor (BAFF) levels were determined in serum samples before vaccination. Vaccination induced a significant increase of IgM and IgG (IgG1 and IgG3) antibodies against both strains in the HC and MTX groups (all P < 0·01), but not in the RTX group. HI correlated significantly in all cases with IgG (IgG1) but not with IgM. In RTX late patients (RTX treatment 6–10 months before vaccination), IgG (IgG1 and IgG3) response to vaccination was restored, but not IgM response. BAFF levels were significantly increased in RA-RTX patients and correlated with total IgG levels. Haemagglutination inhibition assay, used as gold standard, detects primarily IgG (IgG1) responses. IgM- and IgG influenza-specific antibodies increase after vaccination in HC and RA patients except in patients on RTX treatment. BAFF levels are increased in both early and late RTX-treated patients, but do not correlate with an influenza-specific antibody response.
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Prior data show anti-CD20 therapy negatively impacts humoral response to various vaccines, though seroprotection can still occur in rituximab- and ocrelizumab-treated patients.
“Our findings are in line with the previously published data regarding the negative impact of anti-CD20 therapy on the humoral response to various vaccines, although seroprotection could be still achieved after vaccination in rituximab-treated 20 26 34-36 and ocrelizumab-treated 37 patients.”
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- Authors
- Westra, J., van Assen, S., Wilting, K. R., Land, J., Horst, G., de Haan, A., & Bijl, M.
- Affiliations
- University of Groningen (NL)
- Department of Internal Medicine, Division of Infectious Diseases, University of Groningen, Groningen, the Netherlands
- University Medical Center Groningen (NL)
- Department of Medical Microbiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Martini Ziekenhuis (NL)
- Corresponding author
- Westra, J
- ORCID
- Westra, J
- Venue
- Clinical and Experimental Immunology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-09-04
- Volume
- 178
- Issue
- 1
- Pages
- 40-47
- ISSN
- 0009-9104 (ISSN-L)
- 1365-2249
- PMC
- PMC4360192
- OpenAlex
- W2143704653
- Cited by
- 92
- References
- 31
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 11 · 2022: 8 · 2021: 25 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 8 · 2015: 3 · 2014: 1 · 2013: 1
- FWCI
- 5.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical & Experimental Immunology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Roche Nederland and Solvay Pharmaceuticals
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
- Keywords
- rituximab, rheumatoid arthritis, influenza vaccination, humoral immune response, IgM, IgG subclasses, B-cell activating factor, methotrexate, H1N1 influenza, H3N2, hemagglutination inhibition, vaccine response
- MeSH terms
- Rituximab, Antibodies, Viral, Arthritis, Rheumatoid, Female, Hemagglutination Inhibition Tests, Humans, Immunoglobulin G, Immunoglobulin M, Influenza, Human, Influenza Vaccines, Male, Methotrexate, Middle Aged, Vaccination, Influenza A Virus, H1N1 Subtype, Influenza A Virus, H3N2 Subtype, Antibodies, Monoclonal, Murine-Derived
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