What is the effect of total plasma exchange on recent vaccinations?

Comment by InpharmD Researcher

While there is limited data regarding the effects of plasma exchange on vaccines, one article hypothesizes that vaccine efficacy would be diminished if administered 2-4 weeks before or during the treatment. Administering vaccines 1-2 weeks after plasma exchange may be feasible as the cellular immune response is not significantly influenced by the procedure. One limited study suggests that the COVID-19 vaccines are somewhat influenced by total plasma exchange, but the findings require validation in subsequent studies.

Background

A 2022 article discusses how the effects of vaccines are influenced by various immunotherapies, including plasma exchange. Vaccinations consist of being inoculated with an antigen to elicit an antibody and cellular response. The response during plasma exchange has not been systematically studied. Yet the authors presume that vaccine antigens are likely to be removed during plasma exchange if the vaccine is administered 2-4 weeks before the treatment period or during treatment. Plasma exchange does not significantly affect the cellular immune response. Therefore, the authors suggest waiting for a shorter interval of 1-2 weeks after the plasma exchange to administer a vaccine. [1]

References:

[1] Winkelmann A, Loebermann M, Barnett M, Hartung HP, Zettl UK. Vaccination and immunotherapies in neuroimmunological diseases. Nat Rev Neurol. 2022;18(5):289-306. doi:10.1038/s41582-022-00646-5
Literature Review

A search of the published medical literature revealed 1 study investigating the researchable question:

What is the effect of total plasma exchange on recent vaccinations?

Level of evidence

C - Multiple studies with limitations or conflicting results  Read more→


Please see Table 1 for your response.

 

Impact of therapeutic plasma exchange on acquired vaccinal anti-SARS-CoV-2 antibodies

Design

Prospective, open-label study

N= 14

Objective

 To evaluate the evolution of anti-SARS-CoV-2 antibodies' titer over time in vaccinated adult patients treated with therapeutic plasma exchange (TPE)

Study Groups

 Study patients (N= 14)

Inclusion Criteria

 Non-critically ill adult patients, vaccinated against SARS-CoV-2 (any type of vaccine), regularly receiving TPE

Exclusion Criteria

 Treated with therapeutic plasma exchange for an acute condition

Methods

Anti-receptor binding domain (RBD) antibody titers were assessed at three time points (before TPE procedure, immediately after the procedure, and prior to the subsequent procedure). All TPE procedures were performed using Spectra Optia® device, using peripheral venous access and albumin 5% (Alburex®) as replacement fluid.

Duration

 Until the second TPE session (median 21 days)

Outcome Measures

 Anti-RBD titers

Baseline Characteristics

  

Study patients (N= 14)

Median age, years

 57

Female

64.3%

Indication for TPE

Myasthenia gravis

Waldenstrom macroglobulinemia

Cold agglutinin disease

Auto-immune encephalitis

Familial hypertriglyceridemia

MGRS+cryoglobulinemic nephritis

Other

 

6

4

1

1

1

1

4

Anti-SARS-CoV2 vaccine type

Pfizer/BioNtech

mRNA-1273 Moderna

Oxford/AstraZeneca ChAdOx1

 

11

2

1

Median interval between the two mRNA vaccine doses, days

 28

Results

Endpoint

Study patients (N= 13)

Anti-RBD titers, BAU/mL (range)

Before TPE

Immediately after TPE

Before second TPE

 

267.8 (22 to 9132.7)

125.5 (8.6 to 3630.7)

180.3 (11.1 to 5452.7)

Study Author Conclusions

 Though validation on a larger scale is still requested, our study has provided encouraging results concerning TPE's safety and impact on the humoral responses induced by anti-SARS-CoV-2 vaccines.

InpharmD Researcher Critique

 The data was published within a letter to the editor and may not have been peer-reviewed. Because of this, limited information is available regarding the study design and outcomes. Neutralizing antibody levels were not assessed.



References:

Lambert C, Scohy A, Yombi JC, Goffin E, Devresse A. Impact of therapeutic plasma exchange on acquired vaccinal anti-SARS-CoV-2 antibodies. Eur J Intern Med. 2022;100:140-142. doi:10.1016/j.ejim.2022.02.014