COVID-19 vaccine and ocrelizumab

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The proof of the pudding is in the eating of it, not in the pudding or its concealed ingredients. Don’t take my word for it. From New York come two cases that were SARS-CoV-2 (COVID-19) antibody negative after developing COVID-19 while on ocrelizumab.

Both cases were aged 39 and 42, within an age range that would be considered immune competent and therefore fully capable of forming an antibody response. First individual had received ocrelizumab for 4 months, the second 9 months prior to COVID-19 infection. Infection was confirmed by nasal swab, and antibody response was checked on two occasions by two different assays; both negative (see Table below).

Of course, an intact B cell pool is not necessarily needed for an adequate immune response to COVID-19, as these two cases prove. Both, recovered following infection. However, the lack of antibody response has obvious implications of vaccine response. This applies not only to COVID-19, but to the flu vaccines, pneumococcal vaccine, chicken pox vaccine, yellow fever vaccine…

Table: SARS-CoV-2 antibody/immunity test characteristics

Abstract

Mult Scler Relat Disord. 2020 Jun 26;44:102341.

Negative SARS-CoV-2 Antibody Testing Following COVID-19 Infection in Two MS Patients Treated With Ocrelizumab

Jeanine Rempe ThorntonAsaff Harel

Background: It is unknown whether MS disease modifying therapies impact ability to mount an antibody response to SARS-CoV-2.

Methods: Case series and literature review. We report a series of two MS patients who developed COVID-19 while on Ocrelizumab therapy and subsequently exhibited negative SARS-CoV-2 serology.

Results: A 42-year-old man and 39-year-old woman with MS developed COVID-19 while on Ocrelizumab therapy. Neither patient required hospitalization. The man exhibited negative serology at 7- and 9-weeks post-infection. The woman exhibited negative serology at 6- and 12-weeks post-infection.

Conclusions: Large studies are essential to determine whether certain DMTs may blunt SARS-CoV-2 antibody production.

About the author

Neuro Doc Gnanapavan

6 comments

  • Does one need to measure antibodies to be assured that an immune response has been generated? Antibodies are a reflection that a virus has been encountered, but would not a measurable T cell response be the real test?

  • My understanding is that 12% of people in who have PCR +ve COVID never develop antibodies. Larger studies in the population are very important as this study is more sensationalist than useful.

    In addition I keep reading that memory T Cell responses may be more relevant in COVID immunity … How does that fit in with the DMT picture.

  • Have always wondered about flu vaccine, should anti CD20 be timed to be just after annual vaccine?
    Surely, surely there must be data available? Real world data from decades of rituximab? Are people taking anti CD20 more likely to suffer seasonal flu?

    • Good point after COVID-19 they will look properl and the anwer is ptobably going to be yes.

      Read our paper
      Cite as: David Baker, Charles Roberts, Gareth Pryce, et al. COVID-19 vaccine-readiness for ocrelizumab and other anti-CD20-depleting therapies in multiple sclerosis and other autoimmune diseases. Authorea. June 23, 2020. DOI: 10.22541/au.159292858.82650822

      Waiting until the end of the cycle to vacciniate will give you the best chance of getting some response

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