Ocrelizumab vaccine Readiness part 2

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Attenuation of antibody response to SARS-CoV-2 in a patient on ocrelizumab with hypogammaglobulinemia. WL ContePublication stage: In Mulr scler rel disord. DOI: https://doi.org/10.1016/j.msard.2020.102315

A 48-year-old on ocrelizumab (last dose 1/24/2020) presented to a drive up COVID-19 testing site with two days of fever, upper respiratory symptoms, and malaise on March 30, 2020. They tested positive for the antigen to SARS-CoV-2.

Due to worsening shortness of breath, one week later the pwMS presented to the emergency room and was admitted for supportive care. Chest x-ray showed left upper lobe and left lung base pneumonia.

Lymphocytes were normal at 1000/ul, IgG was 5.380 g/L, IgM was <0.250 g/L, and IgA was 1.610 g/L.

Normal Ranges Adult: IgG 6.0 – 16.0g/L (So I gG normal). IgA 0.8 – 3.0g/L. (So normal) IgM 0.4 – 2.5g/L (Low = Hypogammaglobulineamia).

The pwMS did not require oxygen and was discharged 3 days later after clinical improvement. She had a prolonged symptomatic period, requiring over 3 weeks from onset to recover from her shortness of breath and fever and 7 weeks to recover from her malaise.

In early June 2020, the pwMS sought antibody testing and tested negative for SARS-CoV-2 IgG with the Abbott immunoassay. The pwMS had a second specimen tested several days later and it also tested negative with the same immunoassay.

Was this is a false negative? Alternatively had ocrelizumab inhibited this person’s B cell response. As Roche makes the COVID antibody test and they have reported 100 individuals within their pharmacovigilance programme, perhaps they can show us how common a negative test is. At present we do not know what the significance of this. Again it puts the emphasis on non-antibodymechanisms for dealing with the virus. .

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MouseDoctor

5 comments

  • In some vírus its the antibody response thats importante others is the t cell response
    Yet another its a mix if the twi responses

    • It is likely to be a mix but I would say the T cell response is important based on what we know from SARS that is to get rid of the virus, but to stop infection this is where antibodies are good

      • Thanks

        Antibodies are immune responses outside the cell

        T cell are immune responses “inside the cell”

        Obrigado

  • Some people don’t seroconvert after hepatitis B vaccinations, but are still believed to have acquired virus specific humoral immunity so are able to continue undertaking exposure prone procedures in medicine. It would be really interesting to know if this lady, and others like her were immune after further exposure. Obviously, it would be unethical to deliberately expose her to the pathogen again, but this scenario must occur somewhere in the world accidentally eventually.

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