接受Rituximab治療之免疫風濕患者，其感染新冠肺炎住院之預後不受新冠肺炎疫苗之時機影響

SARS-CoV-2 Vaccination Timing did not Predict COVID-19 Outcomes following Hospitalization in Patients with Rituximab-Treated Immune mediated Inflammatory Diseases

目的：Rituximab被廣泛使用在免疫風濕疾病之治療，然而在接受rituximab治療之患者，其注射疫苗（包括新冠肺炎疫苗）後之免疫反應則可能較低。在臨床上關於rituximab治療與新冠肺炎疫苗之間隔，與病人感染新冠肺炎之預後並無明確實證；本研究因此探討rituximab與新冠肺炎疫苗之時間間隔，與接受rituximab之免疫風濕患者其感染新冠肺炎預後之關聯。
方法：我們從曾使用rituximab治療免疫風濕疾病的患者中回溯，收錄在2021年五月至2023年四月之間因新冠肺炎感染而住院之患者。患者其新冠肺炎診斷由嚴重疾病呼吸道症候群冠狀病毒2型之反轉錄酶RNA陽性確定。我們藉由病歷系統回顧與全國性預防接種資訊管理中央資料庫系統，蒐集病人相關臨床與疫苗接種相關資料。透過獨立樣本無母數檢定，探討患者感染新冠肺炎前最後一劑rituximab注射日與新冠肺炎疫苗接種日的間隔（並將這段期間簡稱為RTX_Vac），與因感染新冠肺炎住院後之不良預後（包括嚴重肺炎、病毒持續陽性、全因性死亡率）之關聯性。
結果：本研究共收錄22位患者，其中11位（50.0%）具嚴重肺炎、14位（63.6%）具病毒持續陽性、全因性死亡率為54.5%。我們發現具各項不良預後（包括嚴重肺炎、病毒持續陽性、全因性死亡率）之患者，其RTX_Vac間隔有較長之趨勢，但無顯著統計意義。
結論：接受Rituximab治療之免疫風濕患者，其感染新冠肺炎住院之預後，不受新冠肺炎疫苗之時機影響。

Objective: Rituximab is widely used in immune mediated inflammatory diseases (IMID). Immune response to SARS-CoV-2 vaccination might be low in rituximab-treated patients; however, real-world data regarding COVID-19 outcomes, the chronicity between rituximab therapy and SARS-CoV-2 vaccination remained scarce. We explored the associations of time intervals between rituximab therapy and SARSCoV- 2 vaccination with COVID-19 outcomes in rituximab-treated IMID patients.
Methods: We retrospectively identified rituximab-treated IMID patients hospitalized for COVID-19 infection during May 2021 to April 2023. COVID-19 infection was diagnosed by SARS-CoV-2 RNA rRTPCR assay. The demographics and subsequent medical outcomes were systematically reviewed from the electronic health records. The vaccination history of individual patients was retrieved from the National Immunization Information System (NIIS). The time interval between the date of the last rituximab therapy and the most recent SARS-CoV-2 vaccination (abbreviated as RTX_Vac) was calculated. Associations with adverse outcomes (severity, very delayed viral shedding and all-cause mortality) were explored using the Mann-Whitney U-test.
Results: A total of 22 cases were included. Eleven (50.0%) had severe diseases, 14 (63.6%) had very delayed viral shedding, and 54.5% died. Longer RTX_Vac intervals were seen in patients with adverse COVID-19 outcomes though statistically insignificant.
Conclusion: Timing of SARS-CoV-2 vaccination did not predict adverse prognosis following COVID-19 related hospitalization in rituximab-treated IMID patients.