143. Antibody response to COVID-19 booster vaccine in patients with ANCA vasculitis on Rituximab
Creators: name: Kant1, Sam
name: Duvuru Geetha1
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background:</strong> The COVID-19 vaccine has been associated with a suboptimal response in patients on immunosuppression. Albeit booster doses of the vaccine have led to an increase in number of patients (solid organ transplant recipients and patients with rheumatic disease) achieving an antibody response, a considerable proportion continue to demonstrate none. Administration of rituximab is associated with lower response to the initial vaccine series, with a paucity of data regarding its effect with respect to booster doses. We looked to elucidate the antibody response post booster vaccine doses in patients with anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) on maintenance rituximab, who had no response to the initial vaccine series. <strong>Methods:</strong> AAV patients attending the vasculitis clinic at Johns Hopkins on rituximab therapy were screened for a completion of vaccine series and associated negative antibody response between January 2021 and September 2021. Immunoglobulin G antibodies to spike protein S1 subunit of on SARS-CoV-2 were measured using ELISA at least 1 month post completion of vaccination series and booster doses. Clinical demographics and immunological data were retrieved after review of the electronic health record. Fifteen patients with no demonstrable antibody response received a booster dose. B cell depletion was defined as absolute CD19 count of 0/mm<sup>3</sup>. This study was approved by the Johns Hopkins Institutional Review Board. <strong>Results:</strong> Of the 15 patients, 7 patients had a discernable antibody response to a booster dose. The median age (IQR) was 69 (62-73) years with 7 patients being female and 8 with granulomatosis with angiitis phenotype (rest with microscopic polyangiitis). Seven patients received the Pfizer vaccine, with 6 and 2 patients received Moderna and Johnson &amp; Johnson (J&amp;J) respectively (patients who initially received Pfizer or Moderna completed same booster types). All patients with CD19 depleted at the time of completion of first vaccine series, with 5/7 booster dose responders having B cell reconstitution at the time of administration of third dose of vaccine. Of note, the two patients that demonstrated antibody response despite complete B cell depletion initially received J&amp;J and received booster Pfizer or Moderna doses. <strong>Conclusion:</strong> This is the largest study to elucidate the antibody response to COVID-19 vaccine booster dose in patients on rituximab therapy. B cell reconstitution correlated with booster vaccine response, however, it was possible to generate an antibody response in patients with B cell depletion by combining different types of vaccines. This could be a viable strategy in generating immune response in patients with B cell depletion as consequence of rituximab, thus balancing the need for primary disease control with continued therapy and achieving an essential goal of vaccine immune response in a vulnerable population. <strong>Disclosures:</strong> DG is a consultant to ChemoCentryx and Aurinia. SK has no disclosures <strong>Table 1.</strong> Patient characteristics, immunosuppressive regime, immunological data and details of vaccine administration. F- female, IS- immunosuppression, J&amp;J- Johnson &amp; Johnson, M- male, MPO- myeloperoxidase, N- negative, PR3-proteinase 3, R- reconstitution, RTX- rituximab, S- corticosteroids, SCQ- subcutaneous immunoglobulin, U- undetectable ID Age Gender Ethnicity ANCA type Duration elapsed since booster (years) Vaccine type SP Ab post 2<sup>nd</sup> dose CD19 levels at the time of 2<sup>nd</sup> dose Booster vaccine type Duration elapsed between first vaccine series and 3<sup>rd</sup> vaccine dose (months) SP Ab post 3<sup>rd</sup> dose CD19 levels at the time of 3<sup>rd</sup> dose Relation of last RTX dose to 1<sup>st</sup> dose (months) Relation of last RTX dose to 3<sup>rd</sup> dose (months) IS regime 1 66 M W PR3 4 J&amp;J N &lt;1% Pfizer 3 P U -4 -8 RTX 2 80 F W MPO 6 J&amp;J N &lt;1% Moderna 4 P U -4 -9 RTX 3 69 F W MPO 8 Pfizer N &lt;1% J&amp;J 3 N U -2 -6 RTX 4 66 F W PR3 3 Moderna N &lt;1% Moderna 5 P R -3 -10 RTX 5 69 F W PR3 3 Pfizer N &lt;1% Pfizer 6 N U -1 -8 RTX 6 69 F W PR3 6 Pfizer N &lt;1% Pfizer 6 N R -5 -11 RTX + S 7 73 M W MPO 8 Moderna N &lt;1% Moderna 7 P R -4 -11 RTX 8 55 M W MPO 4 Moderna N &lt;1% Moderna 6 P R -3 -10 RTX 9 50 M W PR3 21 Moderna N &lt;1% Moderna 6 N U -2 -9 RTX + S + SQIG 10 61 M W PR3 1 Pfizer N &lt;1% Pfizer 4 N U -7 -11 RTX 11 65 M W MPO 7 Pfizer N &lt;1% Pfizer 6 N U -6 -12 RTX 12 62 M W PR3 7 Pfizer N &lt;1% Pfizer 4 P R -5 -10 RTX 13 74 F W MPO 4 Moderna N &lt;1% Moderna 8 P R -1 -9 RTX 14 79 M W PR3 7 Pfizer N &lt;1% Pfizer 1 N U -5 -6 RTX 15 73 F A MPO 5 Moderna N &lt;1% Moderna 5 N U -1 -7 RTX