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Rituxan and Vaccines

  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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11 years 8 months ago - 11 years 8 months ago #41358 by Sandi
Rituxan and Vaccines was created by Sandi
This has been discussed many times, but I can't stress the importance of knowing this since it seems that many doctors do not. The timing of vaccines for splenectomized patients before and after Rituxan is crucial. Anyone considering a splenectomy within 6 months of Rituxan should consider the risk of ineffective vaccines.


B-cell depletion may impair vaccine responses and increase infection risk in patients with immune thrombocytopenia (ITP). We investigated the effects of rituximab on antibody and cellular responses to Streptococcus pneumoniae polysaccharide and Haemophilus influenzae type b (Hib) vaccines in ITP patients. Of 60 patients in the main trial, 24 patients received both vaccines 6 months after rituximab (n = 17) or placebo (n = 7). Among 20 evaluable patients, 3 of 14 (21%) in the rituximab group and 4 of 6 (67%) in the placebo group achieved a fourfold increase in anti-pneumococcal antibodies (P = .12). For anti-Hib antibodies, 4 of 14 (29%) and 5 of 6 (83%), respectively, achieved a fourfold increase (P < .05). Fewer patients in the rituximab group demonstrated Hib killing (2 of 14 [14%], 5 of 6 [83%], P < .05). Three of 14 rituximab-treated patients failed to respond to vaccines by any criteria. After vaccinations, preplasma cell blasts and interferon-γ-secreting T cells were Breduced in rituximab-treated patients. Antibody responses were impaired for at least 6 months after rituximab. Cellular immunity was reduced in parallel with depleted B-cell pools. These findings have implications for the timing of vaccinations and the mechanism of infection after rituximab in ITP patients.

www.ncbi.nlm.nih.gov/pubmed/23851398

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  • karenr
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  • Diagnosed in 2000, at 59, after being on moderately high doses of NSAIDs for arthritis. Splenectomy and rituxan both failed (2004). Did well on prednisone till summer 2018--then terrible reactions. Promacta since 11-19.
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11 years 8 months ago #41363 by karenr
Replied by karenr on topic Rituxan and Vaccines
Sandi, I need a course in reading medical journalese! I don't know how you do it!

Is this just the pneumonia vaccine that was studied? And I couldn't see where splenectomized patients were mentioned.

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  • amberyard
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  • Lowest count 0-1k highest count 1,247,000 11/2/21. 189,000 N-Plate 527 Weekly CBC
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11 years 8 months ago #41367 by amberyard
Replied by amberyard on topic Rituxan and Vaccines
www.ncbi.nlm.nih.gov/pubmed/23851398

Saw this today

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  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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11 years 8 months ago #41384 by Sandi
Replied by Sandi on topic Rituxan and Vaccines
Karen:

People who have had a splenectomy often need those vaccines. It would certainly apply to that population, maybe even more importantly than those who have their spleens intact. The article also discussed the Hib vaccine. Those are two of the vaccines required for asplenic patients. I would think it would apply to all vaccines since the premise is the same.

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  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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11 years 8 months ago #41385 by Sandi
Replied by Sandi on topic Rituxan and Vaccines
Amber:

It's the same article. You are a prime example of someone who received vaccines following Rituxan and then had a splenectomy, all in a very short period of time. I was worried about that combination and am glad that you have avoided serious illness!
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