The second first case of the trickle..drip drip, drip,ocrelizumab and COVID-19 vaccines


In this individual ocrelizumab was used for 2 years. The person was vaccinated about two weeks after last infusion and the second Pfizer dose 3 weeks later. Nearly 3 weeks later they tested positive for COVID-19, so had been infected. A few days later there showed an IgM response but no IgG response. But we are no wiser…were they going to seroconvert to make an IgG response? No time to find out they were given anti-COVID antbody. So not that informative.

COVID19 Vaccine Failure in a Patient with Multiple Sclerosis on Ocrelizumab.Chilimuri S et al. Vaccines. 2021;9:219.  The abstract proclaims “We report the first case of COVID-19 vaccine failure in a patient with relapsing-remitting multiple sclerosis on B cell depleting therapy, ocrelizumab. We offer suggestions to improve vaccine efficacy in these patients”.

Sad to say they are wrong on both counts…

They submitted on 17 February 2021 – Accepted: 2 March 2021 -Published: 4 March 2021. But they suggest the solution is wait until the end of the cycle …however sorry to burst their bubble and the other first, first case report says that may not work either. I would ban the use of “this is the first”.. in any paper it is tyically rubbish as invarianbly it is not true..

Khayat-Khoei et al. Negative anti-SARS-CoV-2 S antibody response following Pfizer SARS-CoV-2 vaccination in a patient on ocrelizumab, J Neurol. 2021 Feb 27 : 1–3.doi: 10.1007/s00415-021-10463-3. They submitted on Feb 5 2021 (2 weeks before the first), -Accepted 10 2021 (one week before the otehr was submitted) and published on 27 Feb (one week before the so called first paper)………however in the latter case here they waited to vaccinate just before the next infusion and that didn’t work either.

So I will save these up for MDs Saturday COVID lunch until we get the first paper to say that someone on ocrelizumab seroconverts and the paper with more than one or two people.

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  • Very frustrated about how hands off Roche,MS Society and my provincial MS clinic in Canada are being about COVID-19 vaccine. My attempts to reach out about how to time infusion and vaccine come in the form of generic emails stating follow the advice of your local public health authorities. When I contact the public health authority they tell me to speak to my health care provider. I delayed my infusion 3 extra months (so 9 months total since last infusion) in hopes that this would make me vaccine ready. They would not give me a vaccine under the clinically vulnerable category and MS clinic won’t even speak to me personally! So I went ahead and had my infusion. I am apparently eligible to have a vaccine, according to my age cohort in May if nothing changes with ongoing vaccine roll out. I feel like it will be a waste to be vaccinated so soon after my infusion. Also very disappointed that I am left to fly blindly through this process with the various butt covering I have encountered. I am left to conclude they know getting a vaccine won’t make a difference despite my thoughts about being vaccine ready. I won’t even know if there will be any seroconversion as in Canada, to my knowledge, we are not even looking at this despite the high number of people in Canada with MS. So I read your posts as my only source of direct information with the realization that this is my personal responsibility to inform and protect myself. Thank you for being a brighter star in my night.

    • I think to be fair we are all in an unknown as as for time to infusion and vaccine is an unknown. Roche will be tied to their licence which I think is a 6 weeks wait from vaccine to infusion..Could be wrong.
      Clearly some people will sero convert. I image those with B cell repopulation are likely to do this the best. Based on the Veloce study I think the view was that most people show some response and that was was hoped, Based on the israeli data that is about 20% which is more than the repopulation. I imaging there will be many people that have delayed the infusion to get the vaccine. Information from this will surface soon. The UK and israel are being your guinea pigs

  • Any data on how this patient fared?Symptomatic or not, severity (and guesses as to whether vaccine had any impact on severity)? Interested in incidence of long haul covid too though probably too soon to tell, Looks like this was in my backyard of nyc! Hope they’re ok

  • I have some good news for ocrelizumab patients (although n=1 but better than nothing!)

    I had my two doses of vaccine (Pfizer) 9 months after my last infusion of ocrelizumab. I had been on the medication for 1 year but chose to delay my next dose in the hope of a vaccine. I have sent my blood to the bio diagnostics biocard lab which tests for spike protein antibodies.

    I have heard today that I am positive for SARS COV-2 specific antibodies. Very relieved!! So it is possible to mount a response despite anti CD20 medication.

    MD can I ask – if I go ahead now with my next infusion will it ‘wipe’ antibodies I have already gained? I think the answer is no but basic physiology is not my strong point!

    • This is excellent news I am really, really pleased and if you are the beacon that shows us the way to go that is fantastic news. Long-lived plasma cells do not express CD-20 and should not be affected by ocrelizumab. Some of the shorter-lived cells don’t express CD20 either. Obviously some of the memory cells will get it. There is one paper where this has been looked at and the immune response was maintained. Obviously I can not be sure what will happen next but the risks for no treatment are probably greater than a blunted immune response to COVID. Also if you have antibody response you will have a T cell response. You could also test again in the future but expect the levels to drop with time. I know that there will be others that had abit of a drug holiday. It would be great to know if your CD19 B cells have started to return. I think this will be a good sign.

      Nice to get some good news

      • Thank you 🙂

        When I had my first dose on 8th Dec you said I was the Margaret Keenan of the MS world!! So I’m glad to be able to give positive results after 2 vaccines. Perhaps immunocompromised people should get their jabs 3 weeks apart (as I was lucky enough to)

        • I think that is the plan but it may have something to do with the fact that you took the risk of a treatment holiday.

      • Those of us in the us post jan what tests can we order to check antibodies? Have heard there may be a T cell test too? Any advice? Happy to be a guinea pig too

  • Yay ANONYMOUS! Thank you for sharing your good news! I’m afraid I got a similar flying blind response as Canada Christine about timing. I even supplied Bart’s memo on timing to neuro, but due to risk his advice was 2 weeks after infusion. My infusion got delayed for insurance issue and I begged for jab, but despite being immune compromised group prioritized in my state TX, My need to time vaccine was not part of selection process. I even tracked shipments of vaccine on Gov’t website and contacted vendors timely for spot. No luck. So I had infusion and now have jab scheduled for first avail, which is 8 weeks post. Crossing fingers I get antibody response.

  • I understand that there is uncertainty over the timing of jabs / infusions etc. It is more worrying that local HCPs are not aware of the correct protocol for treating MS patients on anti CD20. Because i read this blog, i chased up my invite to a 3rd dose as i had been invited for a booster. My consultant explained that it was simply an admin exercise i.e. it needs to be logged as a third dose to keep me eligible for a booster in the future. Thats not actually correct though is it as the third dose is double the amount of the booster? i have to say i was a little confused about this myself but the consultants who are advising patients need to know. Jeepers. Anyway, third dose received, after 2 x AZ and wild infection. Currently feeling like crap but hopefully some layer of protection before its all wiped out by HSCT

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