Rituximab-Treated Patients Have a Poor Response to Influenza Vaccination

• DOI: 10.1007/s10875-012-9813-x
• Publication Date: 2012-10-17T22:16:10Z
• Authors: Robert A. Eisenberg; Abbas F. Jawad; Jean Boyer; Kelly Maurer; Kenyetta McDonald; Eline T. Luning Prak; Kathleen E Sullivan
• Keywords: Adult; Male; B-Lymphocytes; Antigens, CD19; Middle Aged; Antibodies, Viral; Lymphocyte Depletion; Immunity, Humoral; 3. Good health; Antibodies, Monoclonal, Murine-Derived; 03 medical and health sciences; 0302 clinical medicine; Influenza Vaccines; Antirheumatic Agents; Immunoglobulin G; Rheumatic Diseases; Influenza, Human; Humans; Female; Lymphocyte Count; Rituximab; Immunologic Memory; Aged

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.