Research: B cell antibodies on vaccination

Kim W, Kim SH, Huh SY, Kong SY, Choi YJ, Cheong HJ, Kim HJ. Reduced antibody formation after influenza vaccination in patients with neuromyelitis optica spectrum disorder treated with rituximab. Eur J Neurol. 2013 Mar 22. doi: 10.1111/ene.12132. [Epub ahead of print]

BACKGROUND AND PURPOSE:Vaccination against infection becomes important in patients with neuromyelitis optica spectrum disorder (NMOSD) because they are at an increased risk of infection due to long-term immunosuppressive therapy. However, it is unclear whether NMOSD patients under immunosuppression therapy show proper antibody formation after vaccination. Thus the antibody formation after influenza A (H1N1) vaccination in patients with NMOSD receiving rituximab was evaluated.
METHODS:The study enrolled 26 patients with NMOSD, nine with multiple sclerosis and eight healthy controls. The enrolled patients had been treated with rituximab (n = 16), mycophenolate mofetil (n = 5), azathioprine (n = 6) and interferon-β (IFN-β) (n = 8). Antibodies against the H1N1 influenza virus were measured in the serum drawn just before (T0) and between 3 and 5 weeks after (T1) vaccination. The immunization states for hepatitis B virus surface antigen, measles and tetanus during the treatment period were also tested.
RESULTS:The rituximab group showed significantly lower geometric mean titer, seroprotection rate and mean fold increase than the azathioprine group, IFN-β group and healthy controls, and a lower seroconversion rate than the IFN-β group. This decrease in vaccination efficacy was also shown in patients receiving mycophenolate mofetil. The immunization state for hepatitis B virus surface antigen, measles and tetanus remained the same during the treatment period with each drug, suggesting that these treatments do not affect previously formed immunity.
CONCLUSION:This study shows a severely hampered humoral immune response to H1N1 influenza vaccine in patients with NMOSD treated with rituximab, although the vaccination itself is safe in these patients.

Although this study is in the neuromyelitis optica version of demyelination, this may be of interest for MSers on B cell immunotherapy. This study looks on the effect of CD20 B cell depletion on the efficacy of vaccination. This treatment inhibited the development of protective immunity but did not affect pre-exsisting immunity. This may be expected as antibody producing B cells called plasma cells do not have CD20 and so are not affected.

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  • I am on Ponesimod, similar to Fingolimod. Tried vaccination against TBE last year. After 3 vaccinations my neuro measured antibodies and they were just about zero. Took another vaccination a week ago, hoping to finally get some antibodies. I am a lot out in the woods and had hundreds of ticks last year, about 10-15 succeeded in biting me, one of which gave me borrelia. I would appreciate some feedback on whether or not there is a point in keeping on trying. Thanks for all the great work you are doing here. Ingrid

    • Thanks for reminding me to get vaccinated
      I did Hep B and after 3 got no antibody reesponse

      Prof G hopefully can post on the issues of vaccination.

      but here is a snippet from Winkelmann

      "Comparably to other immunosuppressive treatment strategies the immune response to vaccines may be hampered during treatment with fingolimod. Thus, on the one hand, vaccination gaps should be closed before initiation of fingolimod treatment and, on the other hand, success of vaccinations during fingolimod therapy may have to be checked by antibody titre assessment".

  • Adjuvants are used to facilitate a stronger humoral immune response in certain vaccines. Influenza vaccine, to my knowledge, does not contain an adjuvant which is normally an alum salt. For this reason the seroconversion to significant protective influenza Abs is only 50-60%. Adjuvant safety in people with immune system mediated diseases has been under some scrutiny. A MS neurologist in Chicago advised MSers not to receive Hep B, small pox or rabies vaccine in that they could spark an exacerbation.

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