166. Rituximab – Patient Management and Outcomes in the Covid-19 era
Creators: name: Cowley1, Sharon
name: Verrelli2, Alyssa
name: Fatemah Alfaraj1
name: Sinead Stoneman2
name: Clarkson2, Michael
name: Grainne Murphy1
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background: </strong>Rituximab (RTX) is a chimeric anti-CD20 antibody that targets B-cells, leading to B cell depletion. It is the treatment of choice for many patients with systemic autoimmune inflammatory rheumatic and renal diseases. In the CoVid-19 era, vaccination of the general population and in particular the vulnerable immunosuppressed population is an essential component of the public health response. Evidence suggests that B cell-depleting therapy with RTX affects humoral immune responses after vaccination. It remains unclear whether RTX-treated patients can develop humoral and T-cell-mediated immune response against SARS-CoV-2 after immunization, and if not, are they susceptible to worse outcomes from CoVid-19 infection. There are also concerns that delaying rituximab to facilitate vaccination may lead to flares of the underlying disease and contribute to significant morbidity and/or mortality. <strong>Methods: </strong>This is a retrospective observational cohort study of patients treated with RTX at a tertiary referral centre.The aim of this study was to determine a) changes in clinical practice in response to the CoVid-19 pandemic, b) the vaccination status of RTX-treated patients c) the incidence and outcomes CoVid-19 infection in RTX treated patients and d) any change in disease activity consequent to changes in RTX treatment schedules. <strong>Results: </strong>A total of 210 patients were included in the study. This included 79 patients with rheumatoid arthritis, 55 with small vessel vasculitis, 25 with systemic lupus erythematosus (SLE), 9 with scleroderma, 5 with myositis, 4 patients with seronegative inflammatory arthritis, 4 with primary sjogrens syndrome, 1 with medium vessel vasculitis, 9 with other forms of connective tissue disease, 8 with membranous nephropathy, 2 with focal segmental glomerulosclerosis, 6 with minimal change disease, 1 with IgG4 disease, 1 with amyloid renal disease and one with an unspecified nephrotic syndrome. 94 patients had their treatment with rituximab delayed, primarily to facilitate augmented vaccination responses. Of these, 48 patients experienced a disease flare (51%). In contrast only 23 of 116 patients who continued RTX experienced a disease flare (19%). 42 patients in the study had their immunosuppression treatment changed for various reasons, predominantly to re-establish disease control following flare. Disease flare was most common in scleroderma, SLE, small vessel vasculitis and RA. At least 184 (87%) of patients were vaccinated against CoVid-19. 13 were not vaccinated, of which 7 chose not to be vaccinated, 2 tested positive for CoVid-19 before the roll out of the vaccine programme and 4 died before the vaccine roll out. The vaccination status of 13 patents could not be ascertained. 16 patients (7.6%) contracted CoVid-19 infection during the pandemic. Of these, 6 were not vaccinated. 37.5% of infected patients required hospitalisation. One patient with RA died of CoVid-19 before the vaccination program commenced. <strong>Conclusions: </strong>Managing patients on RTX in the CoVid-19 era is challenging. Withholding therapy associated with an enhanced risk of disease flare. The majority of our patients chose to be vaccinated. Those who contracted CoVid-19 despite vaccination had worse hospitalisation rates compared to the general population. <strong>Disclosures</strong>: The authors have no financial disclosures relevant to the submitted work