Article Figures & Data
Figures
- Figure 1.
Total SARS-CoV-2 antibody response after receiving 2 vaccinations with COVID-19 mRNA vaccine in patients with rheumatic diseases treated with RTX and controls. (A) Percentage of patients and controls with a measurable antibody response post vaccination. (B) Levels of measured total anti–SARS-CoV-2 antibodies in patients (circles) and controls (crosses). The X-axis shows time since the last treatment with rituximab prior to vaccination. COVID-19: coronavirus disease 2019; n: number of individuals with SARS-CoV-2 antibodies; N: total number of individuals; RTX: rituximab.
Tables
Values Female sex 135 (67) Age, yrs, mean (SD) 58.4 (14.2) Previous COVID-19 infection 7 (3.5) Disease duration, yrs, median (IQR) 7.9 (3.0–8.0) Diagnosis Rheumatoid arthritis 63 (31) Systemic lupus erythematosus 20 (10) AAV (GPA/EGPA) 61/4 (32) Polymyositis/dermatomyositis 28 (14) Systemic sclerosis 10 (5) Other RDs 14 (7) mRNA vaccine used Pfizer/BioNTech 195 (97) Moderna 6 (3) Time from vaccination to blood sample, d, median (IQR) 42 (12–64) DMARD treatment None 52 (25) Prednisone 84 (42) Prednisone dose, mg, median (IQR) 5 (5–10) Methotrexate 51 (25) Hydroxychloroquine 22 (11) Azathioprine 21 (10) Leflunomide 11 (5) Mycophenolate mofetil 9 (4) Ig 6 (3) Cyclophosphamide 2 (1) Sulfasalazine 1 (0.5) Biologic treatment None 35 (17) RTX within last 15 months 145 (72) TNF inhibitors 6 (3) JAK inhibitors 6 (3) IL-6 inhibitors 5 (2) Abatacept 4 (2) Previous RTX treatment, median (IQR) No. of infusions 5 (2–8) Cumulative total dose, mg 4000 (2000–8000) Total treatment timea, d 505 (30–1532) Values are expressed as n (%) unless otherwise indicated.
↵aTime between the first and last RTX treatment before vaccination. AAV: antineutrophil cytoplasmic antibody–associated vasculitis; COVID-19: coronavirus disease 2019; DMARD: disease-modifying antirheumatic drug; EGPA: eosinophilic granulomatosis with polyangiitis; GPA: granulomatosis with polyangiitis; IL: interleukin; JAK: Janus kinase; RD: rheumatic disease; RTX: rituximab; TNF: tumor necrosis factor.
- Table 2.
Univariate logistic regression analysis of antibody response after COVID-19 mRNA vaccination in patients.
OR 95% CI P Univariate logistic regression analysis Sex, female (ref) 0.91 0.50–1.67 0.77 Age, yrs 0.98 0.96–1.00 0.09 Time from vaccination to blood sample, days 1.00 0.99–1.01 0.61 Diagnosis Rheumatoid arthritis Ref Ref Ref Systemic lupus erythematosus 0.57 0.19–1.69 0.31 AAV (GPA/EGPA) 0.83 0.41–1.69 0.61 Polymyositis/dermatomyositis 0.36 0.13–1.02 0.06 Systemic sclerosis 1.33 0.35–5.07 0.67 Other RDs 2.67 0.82–8.71 0.10 RTX exposure RTX treatment within last 15 months 0.21 0.10–0.40 < 0.001 Time between last RTX and vaccination, months 1.06 1.03–1.09 < 0.001 Total no. of RTX infusions 0.96 0.92–1.01 0.10 Total RTX dose, mg 0.97 0.92–1.02 0.18 Time from first to last RTX treatment, months 1.00 1.00–1.00 0.57 DMARD treatment None 0.94 0.50–1.78 0.85 Prednisone, yes/no (no = ref) 0.49 0.27–0.89 0.02 Prednisone dose, mg 0.91 0.85–0.99 0.02 Methotrexate 1.71 0.90–3.25 0.10 Hydroxychloroquine 0.87 0.35–2.19 0.77 Azathioprine 0.23 0.06–0.80 0.02 Multivariate logistic regression analysis Time between last RTX and vaccination, months 1.08 1.04–1.11 < 0.001 DMARD treatment Prednisone dose, mg 0.91 0.84–0.99 0.03 Azathioprine 0.10 0.02–0.44 0.002 Explanatory variables in the univariate model are based on previous knowledge of association to vaccination response and evaluation of RTX exposure. Specific DMARD treatments were included if ≥ 10% of the patients received it. The multivariate model includes all explanatory variables with statistically significant effects in the univariate analysis. “Time from last RTX treatment to vaccination” and “prednisone treatment” were included as continuous variables. Values in bold are statistically significant. AAV: antineutrophil cytoplasmic antibody–associated vasculitis; COVID-19: coronavirus disease 2019; DMARD: disease-modifying antirheumatic drug; EGPA: eosinophilic granulomatosis with polyangiitis; GPA: granulomatosis with polyangiitis; OR: odds ratio; RD: rheumatic disease; RTX: rituximab.
