Although most autoimmune diseases are considered to be CD4 T cell‐ or antibody‐mediated, many respond to CD20‐depleting antibodies that have limited influence on CD4 and plasma cells. This includes rituximab, oblinutuzumab and ofatumumab that are used in cancer, rheumatoid arthritis and off‐label in a large number of other autoimmunities and ocrelizumab in multiple sclerosis. Recently, the COVID‐19 pandemic created concerns about immunosuppression in autoimmunity, leading to cessation or a delay in immunotherapy treatments. However, based on the known and emerging biology of autoimmunity and COVID‐19, it was hypothesised that while B cell depletion should not necessarily expose people to severe SARS‐CoV‐2‐related issues, it may inhibit protective immunity following infection and vaccination. As such, drug‐induced B cell subset inhibition, that controls at least some autoimmunities, would not influence innate and CD8 T cell responses, which are central to SARS‐CoV‐2 elimination, nor the hypercoagulation and innate inflammation causing severe morbidity. This is supported clinically, as the majority of SARS‐CoV‐2‐infected, CD20‐depleted people with autoimmunity have recovered. However, protective neutralizing antibody and vaccination responses are predicted to be blunted until naive B cells repopulate, based on B cell repopulation kinetics and vaccination responses, from published rituximab and unpublished ocrelizumab (NCT00676715, NCT02545868) trial data, shown here. This suggests that it may be possible to undertake dose interruption to maintain inflammatory disease control, while allowing effective vaccination against SARS‐CoV‐29, if and when an effective vaccine is available.

中文翻译：

---

自身免疫性疾病的抗 CD20 消耗疗法的 COVID-19 疫苗准备情况。

尽管大多数自​​身免疫性疾病被认为是 CD4 T 细胞或抗体介导的，但许多自身免疫性疾病对 CD20 耗竭抗体有反应，而这些抗体对 CD4 和浆细胞的影响有限。这包括用于治疗癌症、类风湿关节炎和标签外治疗的大量其他自身免疫性疾病的利妥昔单抗、oblinutuzumab 和 ofatumumab，以及用于治疗多发性硬化症的 ocrelizumab。最近，COVID-19 大流行引起了人们对自身免疫中免疫抑制的担忧，导致免疫治疗的停止或延迟。然而，根据自身免疫和 COVID-19 的已知和新兴生物学，假设虽然 B 细胞耗竭不一定会使人面临严重的 SARS-CoV-2 相关问题，但它可能会抑制感染和疫苗接种后的保护性免疫。因此，药物诱导的 B 细胞亚群抑制至少控制了一些自身免疫，不会影响先天和 CD8 T 细胞反应，而这些反应是 SARS-CoV-2 消除的核心，也不会影响导致严重发病的高凝和先天炎症。这在临床上得到了支持，因为大多数 SARS-CoV-2 感染、CD20 缺失的自身免疫患者已经康复。然而，根据已发表的利妥昔单抗和未发表的 ocrelizumab（NCT00676715、NCT02545868）试验数据的 B 细胞再增殖动力学和疫苗接种反应，预计保护性中和抗体和疫苗接种反应会减弱，直到初始 B 细胞重新增殖为止。这表明，如果有有效的疫苗可用，可以中断剂量以维持炎症性疾病的控制，同时允许针对 SARS-CoV-29 进行有效的疫苗接种。