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  • #31
    Linda, that's scary! I hope that by referring to the reaction as a 2 week long pseudo flair you are indicating a full recovery. Mind if I ask how long after your last Rituxan infusion you got the CoVid vaccination? I completed my vaccinations 9 months after my last Rituxan infusion, and just 2 weeks before my next infusion. I suspect I achieved maximum CoVid antibody protection and then promptly wiped it out with Rituxan but obviously we don't really know.



    • #32
      I was between rituxan infusions so 3 months after infusion and next infusion coming mid and end of June.


      • #33
        Linda, sorry to hear about reaction to 2nd shot. I hope you are feeling better. Did you say in another post that you had pnemonia right before pandemic, which might have been covid? I wonder if you contracted covid last year and had natural occurring antibodies and that's why you had such an intense reaction to vaccine?? I really don't know. Thankfully, you're protected now. Ps I had the medic alert for a time and it was reassuring to know if I fell, I could get help.


        • #34
          What a great post! I don't know if any Aussies will see this post, but I'm trying to reach out widely.

          Covid-19 Research Survey for Australians with MS

          Melbourne, Australia underwent a strict and prolonged lockdown in 2020. This research survey wants to know how Covid-19 affected Australians, both in and out of lockdown, with respect to physical activity levels and venues (indoor/outdoor, for example).

          The survey also asks about MS-specific information and intentions with respect to vaccinations.
          Please help us examine these important topics by filling out this anonymous survey.

          This has been approved by the University of Melbourne ethics committee and will take approx 20 min to complete.

          Thank you for volunteering your time to participate
          ! Your input is greatly valued.


          • #35
            The prevalence of COVID-19 infection in patients with multiple sclerosis (MS): a systematic review and meta-analysisNeurological Sciences (2021)


            The prevalence of COVID-19 is different in studies conducted in different countries. The aim of this systematic review and meta-analysis is to estimate the pooled prevalence of COVID-19 in patients with MS.

            Two independent researchers independently searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature up to April 2021. The search strategy included the MeSH and text words as (((coronavirus OR Wuhan coronavirus OR novel coronavirus OR coronavirus disease OR COVID-19 OR 2019 novel coronavirus infection OR 2019-nCOV OR severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).

            We found 1466 articles by literature search, and after deleting duplicates, 1029 remained. Twelve articles remained for meta-analysis. Totally, 101,462 patients were evaluated and the total number of possible/confirmed cases was 1394. Mean age ranged from 35 to 54 years. Totally, 49 patients died. The pooled prevalence of suspected COVID-19 in MS patients was 4% (95% CI: 3–4%) (I2 = 98.5%, P < 0.001). The pooled prevalence of hospitalization in infected cases was 10% (95% CI: 7–12%) (I2 = 95.6%, P < 0.001). The pooled prevalence of death in hospitalized cases was 4% (95% CI: 1–6%) (I2 = 82.4%, P < 0.001).

            Hospitalization rate is higher among MS patients based on COVID-19 infection while the pooled infection rate is estimated as 4%.
            Dave Bexfield


            • #36
              Booster shoot for immune compromised??? France says yes, CDC says not so fast, And some Americans get on own... Johns Hopkins study ->

              France recommendation June 1, 2021
              3 rd vaccine dose for immune compromised. immune compromised includes:
              • People under strong immunosuppressive treatment (anti-CD20 or anti-metabolites).
              The third dose is recommended four weeks after the second dose, or as soon as possible for people who have already exceeded this time.......They recommend that all severely immunocompromised people receive a quantitative anti-S type serology 30 days after administration of the second dose and the third dose. People also need to be rapidly informed that two doses of any vaccine is only likely to provide very limited protection.”

              Last edited by Suebee; 06-14-2021, 09:06 PM.


              • #37
                Neurol Sci
                . 2021 Jun 15;1-4.
                doi: 10.1007/s10072-021-05397-7. Online ahead of print.

                Preliminary evidence of blunted humoral response to SARS-CoV-2 mRNA vaccine in multiple sclerosis patients treated with ocrelizumab

                Antonio Gallo 1, Rocco Capuano 2, Giovanna Donnarumma 3, Alvino Bisecco 2, Elena Grimaldi 3, Miriana Conte 2, Alessandro d'Ambrosio 2, Nicola Coppola 4, Massimiliano Galdiero 3, Gioacchino Tedeschi 2

                Objectives: Several concerns regard the immunogenicity of SARS-CoV-2 vaccines in people with multiple sclerosis (pwMS), since the majority of them is treated with immunomodulating/immunosuppressive disease modifying therapies. Here we report the first data on the humoral response to mRNA SARS-CoV-2 vaccine in a case series of 4 pwMS treated with ocrelizumab (OCR) as compared to a group of healthy subjects (HS).

                Methods: We collected serum samples at 0, 14, 21 days after the first dose and 7 days after the second dose of BNT162b2-mRNA-Covid-19 vaccine from 55 health-care workers and 4 relapsing pwMS on OCR, with no history of Covid-19 infection. Sera were tested using the LIAISON«SARS-CoV-2 TrimericS-IgG assay (DiaSorin-S.p.A.) for the detection of IgG antibodies to SARS-CoV-2 spike protein. The anti-spike IgGtiters were expressed in Binding Antibody Units (BAU), an international standard unit.

                Results: At baseline all subjects were negative for anti-spike IgG. Seven days after the second dose of vaccine all HS mounted a significant humoral response (geometric mean 2010.4 BAU/mL C.I. 95% 1512.7-2672) while the 4 pwMS showed a lower response (range <4.81-175 BAU/mL).

                Discussion: Humoral response to BNT162b2-mRNA-vaccine in pwMS treated with OCR was clearly blunted. Further data are urgently needed to confirm and expand these preliminary results and to develop strategies to optimize the response to SARSCoV-2 vaccines in pwMS on OCR.

                FREE ARTICLE:
                Dave Bexfield


                • #38
                  Ocrevous causes blunted response. Point of information The article identifies type of spike antibody used:
                  LIAISON«SARS-CoV-2 TrimericS-IgG assay (DiaSorin-S.p.A.). Manufacture says biotin treatment can interfere with test “ specimens from patients receiving therapeutic doses of Biotin (Vitamin H, B7 or B8) may interfere in immunoassays based on biotinylated reagents – interference was not observed testing Biotin serum concentration up to 3500 ng/mL with LIAISON SARS-CoV-2 S1/S2 IgG assay” @ pg 8 https://assets.publishing.service.go...SARS_CoV_2.pdf


                  • #39
                    Hello, I'm trying to get a bit more clarity on how Ocrevus impacted my immune system.

                    I had never taken any anti-CD20 medication when I got the Moderna vaccine. 4 weeks after the second shot, I started Ocrevus for the first time. So did Ocrevus dampen the vaccine's effectiveness? I hadn't been on a DMT for a year and had only ever been on Copaxone. My wishful thinking is that it means my immune response to the vaccine would be more like a person without MS, but that's just a guess.

                    I wasn't too worried until Delta, because my friends/family are all vaccinated.

                    I'll probably try to chat with my dr soon, because I have some travel decisions coming up in late summer and I don't know what to do. Cancel? Mask? What about my plans to attend some big outdoor events?

                    What is everyone else doing?


                    • #40
                      Andrea, I think you should be fine as you stated. But there is always a risk of breakthrough Covid, MS or no. Be smart like you have been. Your neuro will have a better idea and I suggest keeping track of the news. Everything is fuzzy again just when things were looking better!
                      Dave Bexfield


                      • #41
                        Definitely worth a read! -DCOVID-19 vaccines and multiple sclerosis disease-modifying therapiesPublished:July 18, 2021DOI:

                        Much more evidence has emerged since our first editorial in April 2020 on the use of multiple sclerosis (MS) disease-modifying therapies (DMTs) during the pandemic (Giovannoni et al., 2020) and a further publication in MSARDs by Baker and colleagues on the biology underpinning the interaction between DMTs and SARs-CoV-2 (Baker et al., 2020). It is now clear that apart from anti-CD20 therapies (rituximab and ocrelizumab) MS DMTs do not appear to increase the risk of COVID-19 or severe COVID-19 (Sormani et al., 2021; Simpson-Yap et al., 2021; Salter et al., 2021). Importantly, people with MS (pwMS) treated with interferon-beta are less likely to get severe COVID-19 (Sormani et al., 2021), presumably due to its antiviral effects (Monk et al., 2021). The risks of COVID-19 associated with anti-CD20 therapy are relatively small with an approximate doubling of liability compared to people on other DMTs (Sormani et al., 2021; Simpson-Yap et al., 2021.). The most important drivers of severe COVID-19 and death are age, disability and the presence of comorbidities (
                        Sormani et al., 2021; Louapre et al., 2020). Male sex and other social determinants of health such as deprivation and ethnicity also play an important role in outcomes from COVID-19 (Bhaskaran et al., 2021). When counselling individual patients about the doubling of the risk of getting severe COVID-19 when on an anti-CD20 therapy it should be stressed that a doubling of a low risk, particularly a low absolute risk, remains still a low absolute risk. People with MS could use one of the online risk calculators, for example the online QCovid« risk calculator developed by the University of Oxford ( to assess their personal risk.

                        FULL ARTICLE:
                        Dave Bexfield


                        • #42
                          Neurol Neuroimmunol Neuroinflamm. 2021 Jul 14;8(5):e1035.

                          Ocrelizumab Extended Interval Dosing in Multiple Sclerosis in Times of COVID-19

                          Leoni Rolfes 1 , Marc Pawlitzki 1 , Steffen Pfeuffer 1 , Christopher Nelke 1 , Anke Lux 1 , Refik Pul 1 , Christoph Kleinschnitz 1 , Konstanze Kleinschnitz 1 , Rebeca Rogall 1 , Katrin Pape 1 , Stefan Bittner 1 , Frauke Zipp 1 , Clemens Warnke 1 , Yasemin Goereci 1 , Michael Schroeter 1 , Jens Ingwersen 1 , Orhan Aktas 1 , Luisa Klotz 1 , Tobias Ruck 1 , Heinz Wiendl 1 , Sven G Meuth 2

                          PMID: 34261812 DOI: 10.1212/NXI.0000000000001035


                          Objective: To evaluate the clinical consequences of extended interval dosing (EID) of ocrelizumab in relapsing-remitting multiple sclerosis (RRMS) during the coronavirus disease 2019 (COVID-19) pandemic.

                          Methods: In our retrospective, multicenter cohort study, we compared patients with RRMS on EID (defined as ≥4-week delay of dose interval) with a control group on standard interval dosing (SID) at the same period (January to December 2020).

                          Results: Three hundred eighteen patients with RRMS were longitudinally evaluated in 5 German centers. One hundred sixteen patients received ocrelizumab on EID (median delay [interquartile range 8.68 [5.09-13.07] weeks). Three months after the last ocrelizumab infusion, 182 (90.1%) patients following SID and 105 (90.5%) EID patients remained relapse free (p = 0.903). Three-month confirmed progression of disability was observed in 18 SID patients (8.9%) and 11 EID patients (9.5%, p = 0.433). MRI progression was documented in 9 SID patients (4.5%) and 8 EID patients (6.9%) at 3-month follow-up (p = 0.232). Multivariate logistic regression showed no association between treatment regimen and no evidence of disease activity status at follow-up (OR: 1.266 [95% CI: 0.695-2.305]; p = 0.441). Clinical stability was accompanied by persistent peripheral CD19+ B-cell depletion in both groups (SID vs EID: 82.6% vs 83.3%, p = 0.463). Disease activity in our cohort was not associated with CD19+ B-cell repopulation.

                          Conclusion: Our data support EID of ocrelizumab as potential risk mitigation strategy in times of the COVID-19 pandemic.
                          Dave Bexfield


                          • #43
                            I just got the third dose of the Moderna vaccine almost 6 months after my second dose and about 5 months after my last Rituxan infusion. I wanted to do this as soon as possible because the Rituxan infusion was so soon after my second Moderna vaccination I figured whatever B-cells might have developed a response to Covid probably got wiped out by the Rituxan. Turned out Dave just posted a study which found exactly that, particularly with reference to Rituxan. I've copied it below.

                            I had no reaction to the first Moderna shot and only about 6 hours of feeling bad the day after the second one. My reaction to the third shot was worse but still less than a day's worth of feeling like crap and one day after that I felt fine, well enough to go for a bike ride anyway and I have suffered no ill effects since.

                            Ann Rheum Dis
                            . 2021 Aug 6;annrheumdis-2021-220626.
                            doi: 10.1136/annrheumdis-2021-220626. Online ahead of print.Humoral and T-cell responses to SARS-CoV-2 vaccination in patients receiving immunosuppression

                            Maria Prendecki # 1 2, Candice Clarke # 3 2, Helena Edwards 3 2, Stacey McIntyre 3, Paige Mortimer 3, Sarah Gleeson 3 2, Paul Martin 3 2, Tina Thomson 2, Paul Randell 4, Anand Shah 5 6, Aran Singanayagam 7 8, Liz Lightstone 3 2, Alison Cox 4, Peter Kelleher 4 7, Michelle Willicombe 3 2, Stephen P McAdoo 3 2
                            Affiliations expandFree PMC article


                            Objective: There is an urgent need to assess the impact of immunosuppressive therapies on the immunogenicity and efficacy of SARS-CoV-2 vaccination.

                            Methods: Serological and T-cell ELISpot assays were used to assess the response to first-dose and second-dose SARS-CoV-2 vaccine (with either BNT162b2 mRNA or ChAdOx1 nCoV-19 vaccines) in 140 participants receiving immunosuppression for autoimmune rheumatic and glomerular diseases.

                            Results: Following first-dose vaccine, 28.6% (34/119) of infection-na´ve participants seroconverted and 26.0% (13/50) had detectable T-cell responses to SARS-CoV-2. Immune responses were augmented by second-dose vaccine, increasing seroconversion and T-cell response rates to 59.3% (54/91) and 82.6% (38/46), respectively. B-cell depletion at the time of vaccination was associated with failure to seroconvert, and tacrolimus therapy was associated with diminished T-cell responses. Reassuringly, only 8.7% of infection-na´ve patients had neither antibody nor T-cell responses detected following second-dose vaccine. In patients with evidence of prior SARS-CoV-2 infection (19/140), all mounted high-titre antibody responses after first-dose vaccine, regardless of immunosuppressive therapy.

                            Conclusion: SARS-CoV-2 vaccines are immunogenic in patients receiving immunosuppression, when assessed by a combination of serology and cell-based assays, although the response is impaired compared with healthy individuals. B-cell depletion following rituximab impairs serological responses, but T-cell responses are preserved in this group. We suggest that repeat vaccine doses for serological non-responders should be investigated as means to induce more robust immunological response.

                            Last edited by AMFADVENTURES; 08-26-2021, 03:29 PM.


                            • #44
                              It’s such an uncertain time. I enrolled in a study to see if I had any vaccine induced antibodies. I had Pfizer 2 months post Ocrevus infusion. Nope. No antibodies. Zip. Actually .4u/ml and .8u/ml was needed for positive. My friend vaccinated and tested at same time as me had over 1000 U/ml. . I also postponed my bi-annual infusion because of current high level of transmission where I live, full icus, and my family interacts with unmasked unvaccinated public. But, I’ve decided to move ahead with infusion at end of month because I can’t deal with MS getting upper hand . Good luck all ❤️


                              • #45
                                Hey everyone! Just a quick update - covid cases are really rising in CO so I got a third vaccination shot on Wednesday and I’m feeling great.

                                The first Moderna shot earlier this year laid me flat for a week and woke up the MS for several weeks, the second Moderna shot was only slightly better. That first vaccination series seemed to leave me wobbly and MSy for months.

                                This time I chose Pfizer. So far it feels like a very normal response with some body aches and headaches, and ibuprofen makes it go away. There’s absolutely no sign of MS rearing it’s ugly head this time.

                                After my experience with the first shot I almost turned my back on covid vaccination but I’m glad I didn’t. Not sure what explains the various reactions but none have been long lasting.

                                Now with the covid booster and flu shot I’m feeling more confident going into the winter months.