TY - JOUR T1 - Mild COVID-19 despite inadequate antibody response after repeated vaccinations in rheumatic disease patients with rituximab-induced B cell depletion: a case series JF - RMD Open JO - RMD Open DO - 10.1136/rmdopen-2022-002567 VL - 8 IS - 2 SP - e002567 AU - Alexander ten Hagen AU - Elisa Habermann AU - Sandra Hermann AU - Gerd R Burmester AU - Robert Biesen AU - Fredrik N. Albach Y1 - 2022/12/01 UR - http://rmdopen.bmj.com/content/8/2/e002567.abstract N2 - B cell depletion by medications such as rituximab (RTX) is an indispensable therapeutic approach in many autoimmune and oncological indications. Unfortunately, RTX treatment has put patients at higher risk of COVID-19-related hospital admission and death.1 Moreover, RTX treatment and low B cell counts are associated with inadequate antibody responses, even after a third vaccination.2 T cell responses seem largely intact,3 but the impact on clinical protection remains unclear. Given the current predominance of SARS-CoV-2 Omicron sublineages, a reduced neutralisation capacity of antibodies must also be considered. However, this may be mitigated by booster vaccinations, and T cell immunity is largely preserved across variants.4 Overall, Omicron is associated with milder courses of disease.5 Open questions remain regarding immunogenicity and clinical outcomes of COVID-19 in RTX patients, especially after repeated vaccinations and in times of the Omicron variant.In this letter, we present a case series of all 7 patients out of an initial 49 RTX-treated patients with … ER -