嚴重特殊傳染性肺炎疫苗對於長期接受莫須瘤治療的類風濕性關節炎患者有效性的回顧性研究

A Retrospective Study on the efficiency of SARS-CoV-2 Vaccination in Rheumatoid Arthritis patients receiving long-term rituximab

背景：Rituximab是一種抗CD20單株抗體，可消耗B細胞，在過去十年廣泛用於治療類風濕關節炎（RA）。然而，接受長期rituximab治療的患者，對嚴重急性呼吸綜合徵冠狀病毒（SARS-CoV-2）疫苗的免疫反應可能會減弱。本研究旨在評估SARS-CoV-2疫苗對接受長期rituximab治療的RA患者的有效性。
方法：在本研究中，我們於台灣台北榮民總醫院風濕科門診進行回溯性分析。納入2022年5月至2023年7月期間接受rituximab治療超過五年的RA患者。比較已接種疫苗與未接種疫苗患者之間的新冠病毒疾病（COVID-19）感染發生率及結果。
結果：總共納入51名患者。儘管B細胞長期耗竭，已接種疫苗的患者COVID-19感染發生率顯著低於未接種疫苗患者（p = 0.041）。雖然已接種疫苗組與未接種疫苗組相比，與COVID-19感染相關的住院率及死亡率較低，但這些差異未達到統計顯著性（分別為p = 0.157及p = 0.095）。
結論：SARS-CoV-2疫苗對接受長期rituximab治療的RA患者有益，因為它顯著降低感染率，並可能降低嚴重結果的風險，包括住院及死亡。

Background: Rituximab, an anti-CD20 monoclonal antibody that selectively depletes B cells, has been widely used in the treatment of rheumatoid arthritis (RA) over the past decade. However, immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination may be attenuated in patients receiving long-term rituximab therapy. This study aimed to evaluate the effectiveness of SARSCoV- 2 vaccination in RA patients treated with long-term rituximab.
Methods: A retrospective analysis was conducted at the rheumatology clinics of Taipei Veterans General Hospital, Taiwan. RA patients who had received rituximab for more than five years between May 2022 and July 2023 were included. The incidence and outcomes of Coronavirus disease 2019 (COVID-19) infection were compared between vaccinated and unvaccinated patients.
Results: A total of 51 patients were enrolled. Despite prolonged B-cell depletion, vaccinated patients had a significantly lower incidence of COVID-19 infection compared to unvaccinated patients (p = 0.041). Although hospitalization and mortality rates associated with COVID-19 infection were lower in the vaccinated cohort compared to the unvaccinated cohort, these differences did not achieve statistical significance (p = 0.157 and p = 0.095, respectively).
Conclusion: SARS-CoV-2 vaccination is beneficial in RA patients receiving long-term rituximab therapy, as it significantly reduces infection rates and may also lower the risk of severe outcomes, including hospitalization and death.