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

[ActiveMSers]

• 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This article is a preprint and has not been certified by peer review [what does this mean?].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.

Abstract

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.

[ActiveMSers]

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

https://multiple-sclerosis-research....not-fingolimod

[ActiveMSers]

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.

https://multiple-sclerosis-research....0-works-in-ms/

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.

https://multiple-sclerosis-research....20-and-delays/