Ocrevus conundrum and the Covid vaccine

[ActiveMSers]

I just got my latest infusion last week. My legs still are blech, but my upper body is doing okay, which is what the research supports when used to treat progressive MS. The problem? Because of its mechanism of action, vaccines don't mesh well with the drug, as it blunts the immune response. That means if the Covid vaccine is available late fall, taking it then likely will do me jack squat.

The solution? There are no great ones. If I forgo my early January infusion, my B cells will build up enough by next summer for my body to accept the vaccine and mount a defense. But that means no treatment for an extended time.

The other factor to consider: how much help is Ocrevus really doing for me and which is the bigger risk: MS progression or Covid? Grrr.

[ActiveMSers]

And I just read that taking Ocrevus could increase my risk of catching the darn virus. Gack.

https://multiple-sclerosis-research....d20-backpedal/

[Suebee]

Ocrevous risk, ouch

Yes Dave, I m on Ocrevous too, and I've found the data/comments on its risk for covid over the past month both concerning and confusing. Dr. G's blog is best source I've found but I struggle raising up to his level of smarts. My glib understanding is that rituximab and ocrelizumab are considered CD20 therapies because they affect B cells. It basically dampens an immune response. This is of course why MSers take it, but it does prevents a robust antibody response. This prevents vaccinations from having desired protection level. However these drugs are believed to prevent a fatal immune response in phase 2 of covid disease. Great! Sadly it Now appears there is data to show that these drugs make one more susceptible to contracting covid. I dont think this surprised scientists because low neutrophils are often associated with higher risk to catch illnesses. While the drugs do not have an increased covid fatality rate than the gen population, it is a concern if one is taking these drugs and have other comorbidities (i.e., age, weight, diabetes, hypertension, heart disease.) Because that increases ones risk of dying from covid. This is where Dr. G's recommendation that a risk benefit analysis needs to be done for every individual to determine best management. Also underscores importance of self-isolating as much as possible, wearing a mask etc and Yada yada. Dr. G's earlier posted opinion was to stay on drug but plan an exit strategy for when vaccine is available. You probably heard that the best guess by Dr Faucci for widely available vaccine is summer 2021. I dont like timeline, not confident in it, and I need a strong DMD. I plan to stay on drug. It obviously stinks we have no good options, rock and hard place scenario. I think the best we can do is keep as strong physically and mentally as we can, stay the course, reevaluate often and when vaccine is found. Hang in there, you're not alone...

[ActiveMSers]

Ha, they just posted on that topic again today. I guess their opinions are making waves....

https://multiple-sclerosis-research....ine-readiness/

[ActiveMSers]

Looks like I’ll be participating in The Hunker Games for likely, oh, THE NEXT YEAR. Although the science isn’t settled and there may be future recommendations, it appears my DMT of Ocrevus (as well as Rituxan) presents some unique Covid complications.

https://www.msard-journal.com/articl...20)30391-6/pdf

According to the MS Society, those types of DMTs “may be linked to an increased chance of being admitted to hospital or requiring intensive care treatment due to COVID-19.” And a bonus, if I happen to get the virus and recover, the silver lining about potentially being immune no longer applies: I could get it again, as the b-cell depleter prevents the body from building antibodies. The same is true for a future vaccine until the drug has mostly left the system (a year from now in my case?).

This video by neuro Brandon Beaber describes it in layman’s terms: https://youtu.be/7lMPrMUdPZM.

If you are on a b-cell suppressant, be extra vigilant and talk to your neurologist before your next infusion for advice as Covid DMT recommendations continue to evolve. Here are the current recommendations by the MS Society.

https://www.nationalmssociety.org/co...y&utm_content=.

[ActiveMSers]

This is encouraging. -D

COVID‐19 vaccine‐readiness for anti‐CD20‐depleting therapy in autoimmune diseases

David Baker Charles AK Roberts Gareth Pryce Angray S Kang Monica Marta Saul Reyes Klaus Schmierer Gavin Giovannoni Sandra Amor

First published: 16 July 2020 https://doi.org/10.1111/cei.13495

Summary

Although most autoimmune diseases are considered to be CD4 T‐cell or antibody‐mediated, many respond to CD20‐depleting antibodies that have limited influence on CD4 and plasma cells. This includes rituximab, oblinutuzumab, ofatumumab that are used in cancer, rheumatoid arthritis and off‐label in a large number of other autoimmunities, and ocrelizumab in multiple sclerosis.

Recently, the COVID‐19 pandemic created concerns about immunosuppression in autoimmunity, leading to cessation or a delay in immunotherapy treatments. However, based on the known and emerging biology of autoimmunity and COVID‐19, it was hypothesised that whilst B‐cell depletion should not necessarily expose people to severe SARS‐CoV‐2‐related issues, it may inhibit protective immunity following infection and vaccination. As such, drug‐induced B‐cell subset inhibition that controls at least some autoimmunities, would not influence innate and CD8 T‐cell responses, which are central to SARS‐CoV‐2 elimination, nor the hyper‐coagulation and innate inflammation causing severe morbidity. This is supported clinically, as the majority of SARS‐CoV‐2 infected, CD20‐depleted people with autoimmunity, have recovered.

However, protective neutralising‐antibody and vaccination responses are predicted to be blunted, until naïve B‐cells repopulate, based on B‐cell repopulation‐kinetics and vaccination responses, from published rituximab and unpublished ocrelizumab (NCT00676715, NCT02545868) trial data, shown here. This suggests that it may be possible to undertake dose‐interruption to maintain inflammatory disease control, whilst allowing effective vaccination against SARS‐CoV‐29, if and when an effective vaccine is available.

[ActiveMSers]

The docs from Barts breaks it all down here:

https://multiple-sclerosis-research....vaccine-ready/