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. 2024 Jan 31;12(1):e008233. doi: 10.1136/jitc-2023-008233

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© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/.

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CD20 monoclonal antibody inhibitors, PD-1/PD-L1 monoclonal antibody inhibitors and calcineurin inhibitors increase risk of postimmunization COVID-19, which is variably overcome by repeat immunizations. (A) Cumulative incidence of SARS-CoV-2 infection following initial immunization in all patients receiving L01FA: CD20 monoclonal antibody inhibitors (n=251) compared with matched control patients (n=251) (p=0.0095 by log-rank). (B) Effect of multiple immunizations on SARS-CoV-2 infection cumulative incidence following initial immunization in patients receiving L01FA: CD20 monoclonal antibody inhibitors compared with matched control patients (immunosuppressed: 2 immunizations n=59, 3 immunizations n=96, 4 immunizations n=96; immunocompetent: 2 immunizations n=58, 3 immunizations n=103, 4 immunizations n=90) (p=0.0022 by log-rank) (online supplemental table 7) demonstrates HRs). (C) Cumulative incidence of SARS-CoV-2 infection following initial immunization in all patients receiving L01FF: PD-1/PD-L1 monoclonal antibody inhibitors (n=282) compared with matched control patients (n=282) (p=0.0038 by log-rank). (D) Effect of multiple immunizations on SARS-CoV-2 infection cumulative incidence following initial immunization in patients receiving L01FF: PD-1/PD-L1 monoclonal antibody inhibitors compared with matched control patients (immunosuppressed: 2 immunizations n=78, 3 immunizations n=108, 4 immunizations n=96; immunocompetent: 2 immunizations n=66, 3 immunizations n=119, 4 immunizations n=97) (online supplemental table 8 demonstrates p values). (E) Cumulative incidence of SARS-CoV-2 infection following initial immunization in all patients receiving L04AD calcineurin inhibitors (n=407) compared with matched control patients (n=407) (p<0.0001 by log-rank). (F) Effect of multiple immunizations on COVID-19 cumulative incidence following initial immunization in patients receiving L04AD calcineurin inhibitors compared with matched control patients (immunosuppressed: 2 immunizations n=111, 3 immunizations n=169, 4 immunizations n=127; immunocompetent: 2 immunizations n=101, 3 immunizations n=179, 4 immunizations n=127) (online supplemental table 9 demonstrates p values). ATC, Anatomical Therapeutic Chemical.