Losing immunity with ocrelizumab

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We have been posting that vaccine response generation is blunted with ocrelizumab. Likewise we have been reporting that ocrelizumab can increase the risk of a clinical infection of COVID-19.

We have suggested that it may (a) hinder the generation of an immune response to the cold-causing corona viruses, which give cross-reactive protection against SARS-CoV-2. We have shown that this can occur. So it stops the immunity from occurring.

However (b) we suggested it could get rid of this immunity after it had formed so and suggested that it may cause the loss of the immunity to these cross-reactive viral responses.

In the study below it shows that this can be lost with respect to chickpox immunity. Thye became hypogamma globulinemic. (produce low levels of immunoglobulin), which we said could a risk factor for a lack of vaccine response. This occurred quickly after the initial infusion, which is unusual for IgG.

They waited for 7 months before re-vaccination and got nothing but if you read our paper (COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases.Baker D, Roberts CAK, Pryce G, Kang AS, Marta M, Reyes S, Schmierer K, Giovannoni G, Amor S.Clin Exp Immunol. 2020 Jul 16:10.1111/cei.13495), you can see that 7 months is not a long enough break for most indivuals as many take longer than 15 months to repopulate the B cells that create new antibody responses. So a nice case report to back up the science and a further word of warning about anti-CD20 depletion.

Now remember CD20 is unlikely to get rid of the CD8 T cell response that may be important for protection as this person did not get Chicken Pox. This is what needs to be looked at

Varicella Zoster immunity loss in multiple sclerosis patient treated with ocrelizumab.Rapisarda L, Valentino P, Barone S, Torti C, La Gamba V, Fortunato F, Sammarra I, Gambardella A.Clin Immunol. 2020 Aug 7:108554. doi: 10.1016/j.clim.2020.108554. Online ahead of print.

Ocrelizumab is a novel humanized anti-CD20 antibody used for treatment of relapsing remitting and primary progressive multiple sclerosis with evidence of inflammatory activity. Guidelines suggest assessing vaccination status and eventually vaccinate patients with multiple sclerosis before new disease modifying therapy initiation. However, there are not any specific recommendations about vaccinal immunity reassessment after ocrelizumab injection. We describe the case of a patient who loss varicella zoster vaccinal immunity after the first ocrelizumab infusion. It is advisable to reassess vaccinal immunity to isolate non-immune patients and to adopt suitable preventive measures, including close contacts vaccination and avoidance of contacts with active infection.

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MouseDoctor

6 comments

  • OK as we are talking about covid vaccines again, I would like to ask a couple of questions

    First does vaccine production require a 100% pure sample of the virus you are vaccinating against in order to produce a viable vaccine

    Second does any body in this country have a ‘pure sample’ I ask because you are the only people I can ask who would know the answers to these questions. Thanks for your response.

    • I am not a vaccine developer..there are many different vaccine options and not all ar based on the the COVID vaccine….Many vaccines are using the spike protein e.gthe oxford vaccine is a adenovirus expressing the spike protein as it is required for entry but I suspect nucleocapsid may be good because it makes a T cell response this would be missing from the oxfrod vaccine I think. So no is the the answer but to make optimal response it wouldbe best to have the whole virus.

      Tomake drugs for human use you need to limit the number of impurities and I immagin for vaccines you need a pre sample. In the UK the vaccine development is oxford, imperial and UCL to name a few recipients of government cash. Their names will be findable.

  • Has there been sequencing done on the antibodies and B cells isolated from blood pre Ocrevus and post Ocrevus/post new vaccination to determine whether the immune response that is created after the re-immunization is in fact a totally new response and not memory cells that have survived the Ocrevus infusion?

  • Does this always happen, or is it because ocrelizumab was given a short time after administration? Is it possible that long term immunity did not have time to be established? Or all patients on ocrevus will lose acquired immunities over a long time?

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