{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T01:06:49Z","timestamp":1777684009367,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T00:00:00Z","timestamp":1671148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:p>Background: Immunosuppressive agents inhibit COVID-19 vaccine antibody (Ab) responses in patients with systemic rheumatic diseases. Rituximab may fully block Ab responses when B cells become undetected. The effect of detected but low number of B cells due to treatment with a B-cell agent (belimumab and\/or rituximab) has not been established. Purpose: We sought to examine whether there is an association between a low number of B cells due to treatment with belimumab and\/or rituximab and impaired primary COVID-19 vaccination spike Ab responses in patients with systemic rheumatic diseases. Methods: We retrospectively examined Ab responses to COVID-19 vaccinations, especially in relation to B-cell counts after treatment with belimumab and\/or rituximab, in 58 patients with systemic rheumatic diseases: 22 on and 36 not on B-cell agents. We used Kruskal-Wallis and Mann-Whitney U tests for comparison of Ab values between the groups and Fisher exact test for relative risk calculations. Results: Median (interquartile range) postvaccination Ab responses were lower in patients on versus those not on B-cell agents: 3.91 (0.77\u201320.00) versus 20.00 (14.32\u201320.00), respectively. Among patients on belimumab and\/or rituximab, Ab responses of less than 25% of the assay\u2019s upper limit were exclusively observed in those with B-cell counts lower than 40\/\u00b5L. Patients with B-cell counts lower than 40\/\u00b5L exhibit a relative risk of 6.092 (95% CI: 2.75\u201314.24) for Ab responses of less than 25% of the upper limit compared with patients not on B-cell agents. This relative risk remained significant, even after excluding patients with undetected B cells. Conclusion: This retrospective study found an association between low B-cell counts (less than 40\/\u00b5L) and decreased Ab responses to primary COVID-19 vaccination in patients with systemic rheumatic diseases treated with belimumab and\/or rituximab. Despite the small number of patients studied, these findings add to the accumulating evidence on the importance of B-cell count in predicting spike Ab responses to COVID-19 vaccination.<\/jats:p>","DOI":"10.1177\/15563316221142846","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T06:01:51Z","timestamp":1671170511000},"page":"180-186","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Low Peripheral B-Cell Counts in Patients With Systemic Rheumatic Diseases Due to Treatment With Belimumab and\/or Rituximab Are Associated With Low Antibody Responses to Primary COVID-19 Vaccination"],"prefix":"10.1177","volume":"19","author":[{"given":"Jeffrey","family":"Zhang-Sun","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael 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