#COVIDMS Yesterdays post asked about the value of teriflunomide


It was said teriflunomide is imunomodulatory and not immunosuppressive and I said it is supposed to inhibit DNA synthesis and so it maybe immunosuppressive to a proliferating immune response and so what happens to vaccinations?

It seems (90%) most people can make one. So that is good news for people on teri, if they get to make a COVID vaccine.

Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis. Bar-Or A, Freedman MS, Kremenchutzky M, Menguy-Vacheron F, Bauer D, Jodl S, Truffinet P, Benamor M, Chambers S, O’Connor PW. Neurology. 2013; 81:552-8.

OBJECTIVE:To investigate the effect of teriflunomide on the efficacy and safety of seasonal influenza vaccine.

METHODS: The 2011/2012 seasonal influenza vaccine (containing H1N1, H3N2, and B strains) was administered to patients with relapsing forms of multiple sclerosis (RMS) treated for ≥6 months with teriflunomide 7 mg (n = 41) or 14 mg (n = 41), or interferon-β-1 (IFN-β-1; n = 46). The primary endpoint was the proportion of patients with influenza strain-specific antibody titers ≥40, 28 days postvaccination.

RESULTS: More than 90% of patients achieved post-vaccination antibody titers ≥40 for H1N1 and B in all groups. For H3N2, titers ≥40 were achieved in ≥90% of patients in the 7 mg and IFN-β-1 groups, and in 77% of the 14-mg group, respectively. A high proportion of patients already had detectable antibodies for each influenza strain at baseline. Geometric mean titer ratios (post/prevaccination) were ≥2.5 for all groups and strains, except for H1N1 in the 14-mg group (2.3). The proportion of patients with a prevaccination titer <40 achieving seroprotection was ≥61% across the 3 treatment groups and 3 influenza strains. However, fewer patients in the 14-mg than the 7-mg or IFN-β-1 groups exhibited seroprotection to H3N2 (61% vs. 78% and 82%, respectively).

CONCLUSION: Teriflunomide-treated patients generally mounted effective immune responses to seasonal influenza vaccination, consistent with preservation of protective immune responses.

Immune response to neoantigen and recall antigens in healthy subjects receiving teriflunomideECTRIMS Online Library. Bar-Or A. 10/03/13; 34102; P622 . This showed response to a Rabies vaccine. The response was blunted by still present.

To put this in perspective, lets have a quick look at

Stokmaier D, Winthrop K, Chognot C, et al. Efficacy of ocrelizumab on vaccine responses in pateinets with multiple sclerosis (S36.002). Neurology; 90 (15 Suppl): S36.002

Seroprotective titers at 4 weeks against five influenza strains (season 2015/2016 and 2016/2017) ranged from 55.6% to 80.0% in OCRelizumab group and 75.0% to 97.0% in Interferon Beta group

Participants received dual infusion of OCR 300 milligrams (mg) on Day 1 and then on Day 15, and then participants will further receive immunization course at 12 weeks post-OCR treatment until Week 24.

The influenza vaccine was given as an intramuscular injection any time between Day 85 and Day 144 (about 3-5months). The results were assessed 4 weeks later

Percentage Positive

Strain 1 = H1N1CA09Ocrelizumab
35 participants
Beta Interferon
33 participants
Strain 2 = BPHU1333 participants31 participants
Strain 3 = H3N2SW13 30 participants 27 participants

The titre (level).

Pre-Vacination Strain 1126.5(78.2 to 204.4)86.0(55.4 to 133.6)
4 weeks 154.8(103.8 to 230.8) 390.8(264.0 to 578.4)
Pre-Vaccination Strain 2 67.7(49.5 to 92.4) 54.0(34.6 to 84.3)
4 week 84.6(64.3 to 111.3) 43.1(156.3 to 377.9)
Pre-Vaccination Strain 3 110.0(72.9 to 166.0)62.6(41.2 to 95.2)
4 weeks 134.5(94.9 to 190.5) 342.8(219.1 to 536.3)

Although the frequency of people making the antibody response is reduced as is the level of antibody (titre). However, it shows that people can still make an antibody response to new antigens and by inferrence new infections.

Is that good enough? I don’t know.

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    • The ABN probably does not know this data because it hasn’t been published!!!! It is not searchable and so if they did not see the poster at the AAN in 2018 or other meetings they would not know this information. Was it presented at ECTRIMS 2018…I didnt find it and unbelievablley ECTRIMS have stopped searchiing of the pre ECTRIMS2018 congresses so was it presented in 2017.. I only came across it a couple of days ago, by accident

      Maybe they did and though that it was not good enough as a response

    • Does it only clear the peripheral circulation….probably not but the question is how much depletion in spleen lymph nodes bone marrow, we know from rituxima that the lymph glands and bone marrow still have cells..

      Is that only IgM, I suspect not but I will have to read the abstract and the data online.

      ocrelizumab is not going to hit the plasma cells directly for ome time

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