Benjamin Terrier, MD, PhD: Improving Vaccine Response in Patients Receiving Rituximab

Rheumatology Network interviewed ­­­­­­­­­­ Benjamin Terrier, MD, PhD, to discuss his recent American College of Rheumatology Convergence 2022 presentation "Innovative Anti-pneumococcal Vaccine Strategies versus Standard Vaccination Regimen in Patients with ANCA-associated Vasculitides Receiving Rituximab Therapy: A Multicenter Randomized Controlled Trial (PNEUMOVAS)." Terrier is Professor of Internal Medicine at Cochin Hospital in Paris, France.

As patients treated with glucocorticoids and rituximab co-therapy have been shown to be at a higher risk of infection, particularly pneumococcal infections, and vaccine responses in these patients are especially impaired, investigators attempted to develop vaccine strategies to increase immune response in this patient population.

“We always try to improve the prevention of infection, and we only have very few tools that allow us to improve that,” Terrier explained. “It was shown by many different studies, especially in rheumatoid arthritis, that the treatment, and especially the B cell depletion agent, rituximab, which is the most frequent treatment used in this type of disease, was responsible for a lack of efficacy of the vaccine.”

In the multicenter, randomized, phase 2 trial, investigators enrolled patients with ANCA-associated vasculitides (AAV), who are often treated with rituximab. They then compared the standard of care treatment with 2 innovative “reinformed” anti-pneumococcal vaccine strategies, with the primary outcome being clinical response via blood test.

Results indicated that vaccine response with the standard regimen dramatically low; however, both novel strategies were able to significantly improve response.

“I think it opens the way for reinforced vaccination strategy for all vaccines,” Terrier hypothesized. “For instance, during the COVID-19 pandemic, in fact, the vaccine was reinjected more frequently, but there was never a question of increasing the dose at each vaccine. We are mainly focused on trying to define the most important medical needs and to trying to improve that, but I think it was something quite important as a proof of concept in all the vaccine trials in the field of these patients.”