Vaccination Guidance for Patients with Nephrotic Syndrome on RUXIENCE
Introduction to Vaccination Recommendations
- The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend pneumococcal vaccination for all patients with nephrotic syndrome and glomerular disease, especially those receiving immunosuppressants like rituximab, as stated by the Kidney Disease: Improving Global Outcomes (KDIGO) 1, 2, 3, 4
Vaccine Administration
- The American Journal of Kidney Diseases suggests that inactivated vaccines, such as Prevenar 20 and Abrysvo, are not contraindicated during immunosuppressive treatment, but their immunogenicity will be reduced under rituximab treatment, according to the American Journal of Kidney Diseases 5, 6
- The Kidney International guidelines state that trimethoprim-sulfamethoxazole should be considered for Pneumocystis jirovecii prophylaxis in patients receiving rituximab, as recommended by the Kidney International 1, 2, 3, 4
Optimal Timing of Vaccination
- The Reviews in Medical Virology recommend administering vaccines at least 2 to 4 weeks before the first dose of RUXIENCE to allow for an optimal immune response before B cell depletion, as stated by the Reviews in Medical Virology 7
- If vaccination was not done before treatment, wait at least 6 months after the last dose of rituximab to allow for B cell reconstitution, according to the Reviews in Medical Virology 7
Special Considerations for Administration
- The Kidney International guidelines suggest screening for latent tuberculosis, hepatitis B and C, HIV, and syphilis before initiating immunosuppressive treatment, as recommended by the Kidney International 1, 2, 3, 4
- The American Journal of Kidney Diseases recommends excluding Strongyloides infection in patients at risk with elevated peripheral eosinophilia, according to the American Journal of Kidney Diseases 1, 2
Algorithm for Vaccination Decision
- For rituximab-naive patients, administer Prevenar 20 and Abrysvo 2-4 weeks before the first dose of RUXIENCE, as stated by the Reviews in Medical Virology 7
- For patients already on rituximab, evaluate the time since the last dose of rituximab and vaccinate accordingly, as recommended by the Reviews in Medical Virology 7