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Will a Covid booster help if you are on Ocrevus, Rituxan, Gilenya? Not really

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  • Will a Covid booster help if you are on Ocrevus, Rituxan, Gilenya? Not really

    • Efficacy and safety of a third SARS-CoV-2 vaccination in multiple sclerosis vaccine non-responders

    Marton Konig, Hilde Marie Torgauten, Marthias Herstad Overas, Adity Chopra, Aslaug Rudjord Lorentzen, The Trung Tran, et al

    This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.


    Importance: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to protect against coronavirus disease of 2019 (COVID-19) is recommended for patients with multiple sclerosis (pwMS). However, approximately 80% of all pwMS treated with anti-CD20 therapy (rituximab, ocrelizumab) or fingolimod have low or absent humoral immunity after vaccination with two doses of SARS-CoV-2 mRNA vaccines. The efficacy and safety of a third vaccine dose in this group is largely unknown.

    Objective: To characterize the humoral immunogenicity and the safety of a third dose of mRNA-COVID-19 vaccine in anti-CD20- or fingolimod-treated pwMS with low or absent humoral immunity (i.e., anti-SARS-CoV-2 IgG <70 arbitrary units (AU) and <5 AU, respectively) after two vaccinations.

    Design, setting and participants: 130 anti-CD20- or fingolimod-treated pwMS with low or absent humoral immunity despite full vaccination against SARS-CoV-2, received a third dose of SARS-CoV-2 mRNA vaccine. Humoral immunity (i.e., antibody response against SARS-CoV-2) and the frequency and characteristics of side-effects were analyzed in all participants. Exposures: A third vaccine dose against SARS-CoV-2 with BNT162b2- or mRNA-1273-COVID-19 vaccine.

    Main outcomes and measures: Patient- and treatment-specific variables were acquired using a digital questionnaire, the Norwegian Immunization Registry and hospital journals. Humoral immunity was assessed by measuring SARS-CoV-2 SPIKE receptor-binding domain (RBD) IgG response. Low/absent humoral immunity was assumed in cases of AU<70 after anti-SPIKE protein-based serology 3-5 weeks after revaccination.

    Results: A third dose of SARS-CoV-2 mRNA vaccine increased anti-SARS-CoV-2 SPIKE RBD IgG levels significantly. The proportion of patients with assumed protective humoral immunity (anti-SARS-CoV-2 SPIKE RBD IgG > 70 AU) were 25% among patients using anti-CD20 therapy and 7% among those treated with fingolimod. No adverse events were registered during the study period.

    Conclusion and relevance: A third dose of mRNA-COVID-19 vaccine was associated with significantly increased levels of anti-SARS-CoV-2 SPIKE RBD IgG, and hence assumed protective humoral immunity - in anti-CD20- or fingolimod-treated pwMS with low or absent humoral immunity despite full vaccination. The effect of a third vaccine dose was limited and more prominent among those treated with anti-CD20 therapy.
    Dave Bexfield

  • #2
    Here's more discussion on the topic, frustrating!:

    Dave Bexfield


    • #3
      And more...

      More of the same….anti-CD20 inhibits seroconversion, but there is a T cell response. Even if there is an antibody response it is of lower quality. Get vaccinated before anti-CD20 and the vaccine response is like controls.

      Time matters and the longer the interval between dose and vaccine more response.

      Dr. Marton König (i.e. King in Norwegian) appeared on the blog earlier this week and is back again, to further show you what I have been saying for months. “If you want to optimise your antibody response on ocrelizumab you need to consider a delay”. This study is from the next-door neighbour of rituxiland and shows that if you are on rituximab it is perhaps worth considering a delay of 9 months to get a better response, although this would not guarenteee you a response. Now the problem is this is not ocrelizumab data and its repopulation characteristic is likely to be different. Some people think this information is meaningless because it is off-label. I disagree as it tells us what to expect and what to look for with ocrelizumab.

      Dave Bexfield