{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:10:49Z","timestamp":1790169049698,"version":"4.1.0"},"reference-count":42,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018261","name":"Insel Gruppe","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018261","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2022,1,3]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune responses on SARS-CoV-2 vaccination in patients receiving anti-CD20 therapies are impaired but vary considerably. We conducted a systematic review and meta-analysis of the literature on SARS-CoV-2 vaccine induced humoral and cell-mediated immune response in patients previously treated with anti-CD20 antibodies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Embase, Medrxiv and SSRN using variations of search terms \u2018anti-CD20\u2019, \u2018vaccine\u2019 and \u2018COVID\u2019 and included original studies up to 21 August 2021. We excluded studies with missing data on humoral or cell-mediated immune response, unspecified methodology of response testing, unspecified timeframes between vaccination and blood sampling or low number of participants (\u22643). We excluded individual patients with prior COVID-19 or incomplete vaccine courses. Primary endpoints were humoral and cell-mediated immune response rates. Subgroup analyses included time since anti-CD20 therapy, B cell depletion and indication for anti-CD20 therapy. We used random-effects models of proportions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Ninety studies were assessed. Inclusion criteria were met by 23 studies comprising 1342 patients. Overall rate of humoral response was 0.40 (95% CI 0.35 to 0.47). Overall rate of cell-mediated immune responses was 0.71 (95% CI 0.57 to 0.87). A time interval &gt;6 months since last anti-CD20 therapy was associated with higher humoral response rates with 0.63 (95% CI 0.53 to 0.72) versus &lt;6 months 0.2 (95% CI 0.03 to 0.43); p=0&lt;01. Similarly, patients with circulating B cells more frequently showed humoral responses. Anti-CD20-treated kidney transplant recipients showed lower humoral response rates than patients with haematological malignancies or autoimmune disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Patients on anti-CD20 therapies can develop humoral and cell-mediated immune responses after SARS-CoV-2 vaccination, but subgroups such as kidney transplant recipients or those with very recent therapy and depleted B cell are at high risk for non-seroconversion and should be individually assessed for personalised SARS-CoV-2 vaccination strategies. Potential limitations are small patient numbers and heterogeneity of studies included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>This study was funded by Bern University Hospital.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2021-002036","type":"journal-article","created":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T11:40:56Z","timestamp":1643888456000},"page":"e002036","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Humoral and cellular immune responses on SARS-CoV-2 vaccines in patients with anti-CD20 therapies: a systematic review and meta-analysis of 1342 patients"],"prefix":"10.1136","volume":"8","author":[{"given":"Simeon","family":"Schietzel","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hypertension, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Anderegg","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Inselspital University Hospital Bern, Bern, Switzerland"},{"name":"Division of Nephrology, Department of Internal Medicine, Neuch\u00e2tel Hospital Network, Neuch\u00e2tel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9094-9476","authenticated-orcid":false,"given":"Andreas","family":"Limacher","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Born","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5772-6342","authenticated-orcid":false,"given":"Michael P","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9385-8097","authenticated-orcid":false,"given":"Britta","family":"Maurer","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7870-912X","authenticated-orcid":false,"given":"Cedric","family":"Hirzel","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2435-5936","authenticated-orcid":false,"given":"Daniel","family":"Sidler","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7717-651X","authenticated-orcid":false,"given":"Matthias B","family":"Moor","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Inselspital University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,2,3]]},"reference":[{"key":"2025090312370556000_8.1.e002036.1","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-012-9813-x"},{"key":"2025090312370556000_8.1.e002036.2","doi-asserted-by":"crossref","first-page":"2257","DOI":"10.1182\/blood.V100.6.2257","article-title":"Rituximab treatment results in impaired secondary humoral immune responsiveness","volume":"100","author":"van der Kolk","year":"2002","journal-title":"Blood"},{"key":"2025090312370556000_8.1.e002036.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.25034"},{"key":"2025090312370556000_8.1.e002036.4","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1182\/bloodadvances.2021004629","article-title":"Vaccine response following anti-CD20 therapy: a systematic review and meta-analysis of 905 patients","volume":"5","author":"Vijenthira","year":"2021","journal-title":"Blood Adv"},{"key":"2025090312370556000_8.1.e002036.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"2025090312370556000_8.1.e002036.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-220781"},{"key":"2025090312370556000_8.1.e002036.7","doi-asserted-by":"crossref","unstructured":"Hadjadj J , Planas D , Ouedrani A . 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