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Immune Responses to Tetanus Vaccine Unchanged for Patients With RA on Rituximab HOBOKEN, NJ -- January 6, 2010 -- Immune responses to the tetanus vaccine are not changed when rituximab in combination with methotrexate (MTX) was compared with MTX alone in patients with rheumatoid arthritis (RA), according to a study published in the January 2010 issue of the journal Arthritis & Rheumatism. However, responses to a pneumococcal vaccination (Pneumovax) were reduced in RA patients with rituximab. The study, led by Clifton O. Bingham III, MD, Johns Hopkins University, Bethesda, Maryland, enrolled 103 patients with RA from 26 centres in the United States between January 2006 and December 2007. Patients treated with a stable dose (10-25 mg/week) of MTX were randomly assigned to receive placebo or treatment with rituximab (2 x 1000 mg given 2 weeks apart). Both groups were immunized with the tetanus and pneumococcal vaccines along with keyhole limpet hemocyanin (KLH) to evaluate humoral immunity and skin tested with Candida albicans to evaluate the cellular immune response. Results indicate that 39.1% of patients in the rituximab/MTX group and 42.3% of patients in the MTX monotherapy group demonstrated a 4-fold rise in the anti-tetanus IgG titer. A 2-fold rise was confirmed in 54.7% of rituximab-treated patients and 61.5% of MTX-only patients. The research demonstrates that RA patients given a tetanus vaccine responded the same to tetanus vaccination regardless of whether they received MTX alone or rituximab in combination with MTX. Patients treated only with MTX had a greater response to the pneumonia vaccine compared with those also receiving rituximab. Researchers found that only 57% of patients treated with rituximab had a response to 1 type of pneumococcal vaccine (Pneumovax) compared with 82% of MTX-only patients. The ability to maintain a positive delayed-type hypersensitivity (DTH) response to the Candida albicans skin test was comparable in both groups with 77.4% of rituximab-treated patients and 70% of MTX-only patients responding. “Our study, the first to examine DTH responses, confirmed that rituximab had no incremental effect on the patient’s ability to mount a DTH response,” said Dr. Bingham. SOURCE: Wiley-Blackwell E-mail this page to a friend or colleague! To print, use this version