Ocrelizumab inhibts vaccine responses

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Ocrelizumab blunts the vaccination response this is shown in a trial if you want to read about it straight from the Horses mouth you can read below but it is behind a pay wall, if you want to see what was shown you can see it for free here.

Baker D, Roberts CA, Pryce G, et al. COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases [published online ahead of print, 2020 Jul 16]. Clin Exp Immunol. 2020;10.1111/cei.13495. doi:10.1111/cei.13495

The paper above surfaced a month ago we did this because it was relevant to COVID-19 safety. This data was put online in Feb 2020. However the company-related version (below) was submitted over a year ago in May 2019 and the authors probably have Killestein J, Du Pasquier R, Hemmer B. to thank for this long delay as the people doing the editorial generally review the paper. I knew this was coming because someone unrelated to the either of the papers had said this in a talk…How did they know? Did the authors slip them an advanced copy or had the refereees blabbed. There is an inner circle of clinical knowledge that you or I have to wait until it surfaces.

However we know know that ocrelizumab appears to limit the antibody response in some people taking ocrelizumab, we also know that COVID-19 vaccines are coming. I wonder how this fact will influence descisions. Remember it seems that a T cell response may be all that you need to defend yourself against COVID-19. I guess we will find out.

The chums of Oxbridge in government have relaxed their lockdown policy just in time to create a second wave, so that it will be easier to test the Oxford-Vaccine….. and in the US is seems they never stopped making it easy for the Moderna vaccine. Yes I am talking a load of old cobblers but it makes you wonder. It seems the makers of alemtuzumab are thinking COVID-19 vaccination is best way forward as they know how to may agents that give a good antibody response;-)

Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis: The VELOCE study. Bar-Or A, Calkwood JC, Chognot C, Evershed J, Fox EJ, Herman A, Manfrini M, McNamara J, Robertson DS, Stokmaier D, Wendt JK, Winthrop KL, Traboulsee A.Neurology. 2020 Jul 29:10.1212/WNL.0000000000010380. 

Objective: The phase IIIb VELOCE study (NCT02545868) assessed responses to selected vaccines in ocrelizumab (OCR)-treated patients with relapsing multiple sclerosis.

Methods: Patients were randomized 2:1 into Group OCR (n=68; OCR 600mg); or Control (n=34; interferon-β or no disease-modifying therapy). All received tetanus toxoid (TT)-containing vaccine, Pneumovax® (23-PPV) and keyhole limpet hemocyanin (KLH). Group OCR was subdivided into OCR1 (n=33) and OCR2 (n=35) at randomization. OCR1 received Prevnar® (13-PCV) 4 weeks after 23-PPV; OCR2 and Control received influenza vaccine. Vaccinations started 12 weeks after OCR initiation (Group OCR) or on Day 1 (Control).

Results: Positive response rate to TT vaccine at 8 weeks was 23.9% in OCR vs 54.5% in Control. Positive response rate to ≥5 serotypes in 23-PPV at 4 weeks was 71.6% in OCR and 100% in Control. Prevnar® did not enhance response to pneumococcal serotypes in common with Pneumovax®. Humoral response to KLH was decreased in OCR vs Control. Seroprotection rates at 4 weeks against five influenza strains ranged from 55.6-80.0% in OCR2 and 75.0-97.0% in Control.

Conclusion: Peripherally B-cell depleted OCR recipients mounted attenuated humoral responses to clinically relevant vaccines and the neoantigen, KLH, suggesting use of standard non-live vaccines while on OCR treatment remains a consideration. For seasonal influenza vaccines, it is recommended to vaccinate patients on OCR, as a potentially protective humoral response, even if attenuated, can be expected.

Vaccination in B-cell depleted MS patients.Killestein J, Du Pasquier R, Hemmer B.Neurology. 2020 Jul 29:10.1212/WNL.0000000000010378. doi: 10.1212/WNL.0000000000010378. 

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