Practical recommendations for revaccination following BCMA-targeted therapies in adult patients with autoimmune diseases

B-cell-directed immune-reset therapies are emerging as transformative approaches in autoimmune diseases, but their impact on long-term humoral immunity remains uncertain. These strategies encompass a broad range of B-cell targets and therapeutic modalities, the most clinically established targets include CD19, CD20, and B-cell maturation antigen (BCMA), with T-cell-redirecting approaches, particularly chimeric antigen receptor T-cell therapies and bispecific T-cell engagers, among the most validated modalities. Here, we aim to provide a practical framework for revaccination in patients with autoimmune diseases.

We examine existing clinical evidence on the effects of BCMA-targeting therapies with respect to antivaccine titres to provide a revaccination framework in autoimmunity.

Current clinical evidence suggests that BCMA-targeting therapies reduce vaccine-specific antibody titres along with total immunoglobulin levels. Insights from oncology studies provide a framework for understanding antivaccine responses in the context of profound BCMA-directed cell depletion, with the caveat that important differences exist between patients with autoimmunity and those with malignancies, including the magnitude and duration of immunosuppressive treatment.

We propose a pragmatic revaccination approach after BCMA-targeting therapies in adult patients with autoimmune diseases, utilising minimal serologic monitoring. Future studies of these novel drugs will refine our understanding of the optimal timing and need for revaccinations in this population.