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OPINION: Switching from an anti-CD20: the why and the how

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  • OPINION: Switching from an anti-CD20: the why and the how

    Interesting read if you are on Ocrevus, Rituxan, or Kesimpta. From a leading MS neuro.... -D

    Switching from an anti-CD20: the why and the how

    Many people with multiple sclerosis on ocrelizumab or rituximab are wanting to switch to another disease-modifying therapy. In this Newsletter I explain why and how to do it.
    Over the last 12 months, I have had an increasing number of queries from my patients, readers of this newsletter and HCPs about switching from an anti-CD20 therapy (ocrelizumab or rituximab) to another DMT. The questions have generally been about what agents to switch to, the timing and how to do it safely. This answer to these questions is quite complex and the answers depend on why someone is switching from an anti-CD20.

    So why are you switching from ocrelizumab or rituximab to another DMT; vaccine readiness, ongoing disease activity, smouldering MS, tolerability, safety issues?
    Dave Bexfield

  • #2

    doi: 10.1101/2021.08.23.21262472. Preprint

    Discordant humoral and T cell immune responses to SARS-CoV-2 vaccination in people with multiple sclerosis on anti-CD20 therapy

    Sachin P Gadani, Maria Reyes-Mantilla, Larissa Jank, Samantha Harris, Morgan Douglas, Matthew D Smith, Peter A Calabresi, Ellen M Mowry, Kathryn C Fitzgerald, Pavan BhargavaFree PMC article


    Background: Sphingosine-1-phosphate receptor (S1P) modulators and antiCD20 therapies impair humoral responses to SARS-CoV-2 mRNA vaccines. Whether disease modifying therapies (DMTs) for multiple sclerosis (MS) also impact T cell immune response to vaccination is unknown.

    Methods: In 101 people with MS, we measured humoral responses via an immunoassay to measure IgG against the COVID-19 spike S1 glycoprotein in serum. We also measured T cell responses using FluoroSpot assay for interferon gamma (IFN-γ) (Mabtech,Sweden) using cryopreserved rested PBMCs and then incubated in cRPMI with 1g/ml of pooled peptides spanning the entire spike glycoprotein (Genscript, 2 pools; 158 peptides each). Plates were read on an AID iSpot Spectrum to determine number of spot forming cells (SFC)/10 6 PBMCs. We tested for differences in immune responses across DMTs using linear models.

    Findings: Humoral responses were detected in 22/39 (56.4%) participants on anti-CD20 and in 59/63 (93.6%) participants on no or other DMTs. In a subset with immune cell phenotyping (n=88; 87%), T cell responses were detected in 76/88 (86%), including 32/33 (96.9%) participants on anti-CD20 therapies. AntiCD20 therapies were associated with an increase in IFN-γ SFC counts relative to those on no DMT or other DMTs (for antiCD20 vs. no DMT: 425.9% higher [95%CI: 109.6%, 1206.6%] higher; p<0.001; for antiCD20 vs. other DMTs: 289.6% [95%CI: 85.9%, 716.6%] higher; p<0.001).

    Interpretation: We identified a robust T cell response in individuals on anti-CD20 therapies despite a reduced humoral response to SARS-CoV-2 vaccination. Follow up studies are needed to determine if this translates to protection against COVID-19 infection.
    Dave Bexfield