We have seen one paper in MS…this is going to be repeated…Why because they use anti-CD20 (rituximab) in MS. In arthritis they are seeing blunting too.
Spiera et al. Rituximab, but not other antirheumatic therapies, is associated with impaired serological response to SARS- CoV-2 vaccination in patients with rheumatic diseases .http://dx.doi.org/10.1136/annrheumdis-2021-220604
There is a paucity of data on the effect of antirheumatic drugs on serological responses to COVID-19 vaccines. Anti-CD20 therapies deplete B-cells, with reconstitution often not beginning for 6–9 months after infusion, resulting in diminished humoral immune responsiveness…… serological response to vaccination was assessed using a semiquantitative anti-SARS-CoV-2 enzyme immunoassay…..Vaccination responsiveness was compared between patients receiving various antirheumatic medications. In patients treated with rituximab time between most recent administration of drug and vaccination was recorded. Exposure to rituximab was defined as having ever been treated, however, all patients were within 4.5 years (median (IQR) 0.70 (0.41–1.74)) years of last exposure. B-cell reconstitution at time of anti-SARS-CoV-2 antibodies measurement was documented, when available, for rituximab-treated patients………Eighty-nine patients met criteria for inclusion. Eighty-three subjects (93.26%) had received both doses of a COVID-19 vaccine at the time of immunoassay. Thirty patients (34%) were treated with rituximab.………A majority of the serologically negative results were among patients using rituximab (20/21)…..Among rituximab users, there was a significant difference in the number of days between those with a positive serological response (median, IQR 704.5 (540–1035) days i.e.= greater than 18 months) compared with those with a negative response (median, IQR 98 (64-164) days = less than 5 months) (p<0.001). B-cell reconstitution was available for 11 patients and there was a significant difference among those with a positive serological response (N=7) compared with those with a negative response, (N=4) (p=0.026).……..Patients who had even weak levels of B-cell reconstitution had higher rates of seropositive responses to vaccines, while B-cell depleted patients invariably demonstrated a negative serological response to vaccination. Importantly, absence of a detectable antibody response to COVID-19 vaccines does not imply absence of improved immunity relative to prior to vaccination in those patients, recognising that other facets of immunity may be enhanced by vaccination.
So this says if you want to make an antibody response it looks like it is better to wait until your B cells start to repopulate, however, this could be a considerably long wait and longer than the 6 months used between typical dosing. Now often in arthrtis they use drugs in addition to rituximab like methotrexate and this may add to the anti-vaccine response. However, will MS be better? I am not holding my breath. We will soon see an avalanche of data saying the same thing. This may give us a clue how long the delay would need to be to get a vaccine response or more likely show us if when you are not likely to respond. However I believe that waiting for 5 months to start just before the next infusion, is not the solution for some people.
So we best get those registries going to find out if people treated with anti-CD20 get re-infected and what happens when this happens. I suspect people will be OK, because people were generally OK when they got COVID-19 before vaccination.
On the plus side there is a reasonable chance you will make a T cell response and we have had examples of people commenting on the blog to say just this. Importantly if you do not make antibodies I believe there are ways to give you protective antibodies. For example the makers of the anti-CD20 MS drugs have anti-SARS-CoV-2 antibodies. Sadly they and the World focused on treating people infected with the virus, generally starting way too late to show any benefit, rather than using it as a prevention against infection. Those studies are ongoing with a different antibody in the UK, it should have been tested on front line health care workers ages and you would have had an answer by now. One trial is called Stormchaser…..maybe this should be done in India.
However, also remember there is a balance and in some instances B cell responses are damaging. We have suggested that prior immune responses to cross-reactive cold-causing coronavirus could be beneficial but in some cases they are damaging
Disclaimer: Please note that the opinions expressed here are those of author and do not necessarily reflect the position of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust.