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. .