TY - JOUR T1 - Effects of casirivimab/imdevimab on systemic and mucosal immunity against SARS-CoV-2 in B-cell depleted patients with autoimmune rheumatic diseases refractory to vaccination JF - RMD Open JO - RMD Open DO - 10.1136/rmdopen-2022-002323 VL - 8 IS - 1 SP - e002323 AU - Filippo Fagni AU - Katja Schmidt AU - Daniela Bohr AU - Larissa Valor-Méndez AU - Fabian Hartmann AU - Koray Tascilar AU - Karin Manger AU - Bernhard Manger AU - Arnd Kleyer AU - David Simon AU - Georg Schett AU - Thomas Harrer Y1 - 2022/05/01 UR - http://rmdopen.bmj.com/content/8/1/e002323.abstract N2 - B-cell depleting therapy is a mainstay to treat autoimmune rheumatic diseases characterised by autoantibody production. While B cells depletion effectively turns down autoimmune inflammation, it also hampers the development of protective immunity after infections and vaccination. The latter has become of particular concern, as treatment with anti-CD20 antibody rituximab is associated with more severe courses of COVID-191 and abolished or severely impaired humoral responses to SARS-CoV-2 vaccination.2While newly initiated B-cell depletion is usually preceded by SARS-CoV-2 vaccination, several situations leave patients without protective immunity during treatment. These include (1) pre-existing B-cell depletion before vaccination was available, (2) vaccination refusal and (3) loss of vaccination response during treatment. In addition, B-cell depletion is often long-lasting and needs to be repeated to prevent potentially life-threatening flares. Therefore, strategies need to be developed providing anti-SARS-CoV-2 immunity in such patients. Several neutralising monoclonal antibodies (mAbs) against spike S1 protein of SARS-CoV-2 have been developed. Casirivimab and imdevimab are two recombinant IgG1 mAbs that bind the receptor-binding domain of the SARS-CoV-2 spike protein and prevent its binding to the angiotensin-converting enzyme 2 at low concentrations (31pM). Use of casirivimab/imdevimab combination has been shown to reduce hospitalisations and deaths from COVID-19.3We analysed 22 patients with autoimmune rheumatic diseases … ER -