Table 3.

Summarized data from all studies listed in Table 1, by average duration of time since last anti-CD20 therapy

Duration of time since anti-CD20 therapySummarized SP rate, %Summarized SC rate, %Summarized SR rate, %
Pandemic influenza (N = 13 studies, 222 patients treated with anti-CD20 therapy)*    
 Active treatment, <3 mo 0-3330-34,40,61  0-2530-34,40   
 3-6 mo 1960  3860  38-4443  
 6-12 mo 5040  5040   
 >12 mo 66-10040,44  66-10040,44   
Seasonal influenza (N = 12 studies, 252 patients treated with anti-CD20 therapy)†    
 Active treatment, <3 mo 8-2530,64  030,35   
 3-6 mo 56-8062  10-6062   
 6-12 mo 69-7763  2535  1742  
 >12 mo 23-7944,52  3-4344,52   
Tetanus, diphtheria, and pertussis (12 studies, 309 patients treated with anti-CD20 therapy)‡    
 Active treatment, <3 mo 10062  24-2536,62   
 3-6 mo 64-7367  9-3966,67   
 6-12 mo 66-9350,69  7-2069  31-6950,65,68,70  
 >12 mo 0-947,53  9-7546,53  047  
Haemophilus influenzae B (3 studies, 52 patients treated with anti-CD20 therapy)    
 Active treatment, <3 mo    
 3-6 mo    
 6-12 mo  2938  73-77 after 1-2 doses68  
 >12 mo  8546   
Hepatitis B (3 studies, 61 patients treated with anti-CD20 therapy)§    
 Active treatment, <3 mo    
 3-6 mo    
 6-12 mo    
 >12 mo 56-6454,71  5654   
Hepatitis A (2 studies, 57 patients treated with anti-CD20 therapy)    
 Active therapy, <3 mo 047    
 3-6 mo    
 6-12 mo 47 (slightly lower than disease controls of 67)70    
 >12 mo    
Polio virus (3 studies, 49 patients treated with anti-CD20 therapy)ǁ    
 Active treatment, <3 mo   2036  
 3-6 mo    
 6-12 mo    
 >12 mo   62, slightly lower than in disease controls (80)46  
Pneumococcal conjugate (PCV-7) (1 study, 55 patients treated with anti-CD20 therapy)    
 Active treatment, <3 mo   5, compared with 21-50 in disease controls73  
 3-6 mo    
 6-12 mo    
 >12 mo    
Pneumococcal polysaccharide (PCV-23) (7 studies, 217 patients treated with anti-CD20 therapy)    
 Active treatment, <3 mo 2530  030   
 3-6 mo   19 to ≥6 serotypes66  
 6-12 mo 33 (to ≥7 serotypes) to 4168  20-2138,69  2965  
 >12 mo    
Duration of time since anti-CD20 therapySummarized SP rate, %Summarized SC rate, %Summarized SR rate, %
Pandemic influenza (N = 13 studies, 222 patients treated with anti-CD20 therapy)*    
 Active treatment, <3 mo 0-3330-34,40,61  0-2530-34,40   
 3-6 mo 1960  3860  38-4443  
 6-12 mo 5040  5040   
 >12 mo 66-10040,44  66-10040,44   
Seasonal influenza (N = 12 studies, 252 patients treated with anti-CD20 therapy)†    
 Active treatment, <3 mo 8-2530,64  030,35   
 3-6 mo 56-8062  10-6062   
 6-12 mo 69-7763  2535  1742  
 >12 mo 23-7944,52  3-4344,52   
Tetanus, diphtheria, and pertussis (12 studies, 309 patients treated with anti-CD20 therapy)‡    
 Active treatment, <3 mo 10062  24-2536,62   
 3-6 mo 64-7367  9-3966,67   
 6-12 mo 66-9350,69  7-2069  31-6950,65,68,70  
 >12 mo 0-947,53  9-7546,53  047  
Haemophilus influenzae B (3 studies, 52 patients treated with anti-CD20 therapy)    
 Active treatment, <3 mo    
 3-6 mo    
 6-12 mo  2938  73-77 after 1-2 doses68  
 >12 mo  8546   
Hepatitis B (3 studies, 61 patients treated with anti-CD20 therapy)§    
 Active treatment, <3 mo    
 3-6 mo    
 6-12 mo    
 >12 mo 56-6454,71  5654   
Hepatitis A (2 studies, 57 patients treated with anti-CD20 therapy)    
 Active therapy, <3 mo 047    
 3-6 mo    
 6-12 mo 47 (slightly lower than disease controls of 67)70    
 >12 mo    
Polio virus (3 studies, 49 patients treated with anti-CD20 therapy)ǁ    
 Active treatment, <3 mo   2036  
 3-6 mo    
 6-12 mo    
 >12 mo   62, slightly lower than in disease controls (80)46  
Pneumococcal conjugate (PCV-7) (1 study, 55 patients treated with anti-CD20 therapy)    
 Active treatment, <3 mo   5, compared with 21-50 in disease controls73  
 3-6 mo    
 6-12 mo    
 >12 mo    
Pneumococcal polysaccharide (PCV-23) (7 studies, 217 patients treated with anti-CD20 therapy)    
 Active treatment, <3 mo 2530  030   
 3-6 mo   19 to ≥6 serotypes66  
 6-12 mo 33 (to ≥7 serotypes) to 4168  20-2138,69  2965  
 >12 mo    
*

See Tables 4 and 5 for meta-analyzed data. In all studies, SP, SC, and/or SR rates were similar or lower in anti-CD20–treated patients than healthy controls or disease controls. One study did not report the average duration since last dose of anti-CD20 therapy but had SP and SR rates of 0% and 0% to 9%, respectively.45 One study indicated that patients had received anti-CD20 therapy <12 months ago but did not specify the average time interval, and reported a SP rate of 9%.59 

†

In all studies, SP, SC, and/or SR rates were lower in anti-CD20–treated patients than in healthy controls or disease controls.

‡

In all studies, SP, SC, and/or SR rates were similar or lower in anti-CD20–treated patients than healthy controls or disease controls. Other than in 2 studies47,53 (a study of patients post–autologous stem cell transplant plus rituximab for non-Hodgkin lymphoma, and a study of pediatric patients treated with rituximab for relapsing/steroid-dependent idiopathic nephrotic syndrome) where the SP rates were only 0% to 9%, SP rates were moderate to high regardless of the duration that had elapsed from anti-CD20 therapy.

§

One study did not report the interval after anti-CD20 therapy during which patients were vaccinated.72 Overall values for anti-CD20–treated patients were similar to healthy controls ≥55 years and disease controls, but worse than healthy controls ≤35 years.

ǁ

One study did not report the interval after anti-CD20 therapy during which patients received vaccination but had a SR rate of 91%.54 

All studies showed that SP, SC, and/or SR rates were lower in anti-CD20–treated patients compared with disease controls.

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