Israel got off to a flying start with their vaccination programme, and then the UK got out of the starting blocks quickly. We would know about the effect of MS drugs on COVID-19 if the second dose of vaccine was at 3-4weeks. However, in stepped the Joint vaccinations committee to throw away the purpose of doing trials and the UK became the first country in the World to put the gap between doses at 12 weeks. Most others did not. Whilst this perhaps could make sense for the Astazeneca vaccine and the Gongs have been showering down, it went outside any of the safety information for the Pfizer vaccine. Maybe you can say that this has paid off because the UK vaccinated more people quickly and that has reduced the death rate. But what about the effect of MS drugs on the vaccine response. The news coming out of israel is that anti-CD20 and fingolimod block the antibody response…but now the UK trickle is arriving…get ready for the flood…it will be an onslaught and bad news for anti-CD20 treatment and vaccination in relation to autoimmunity.
Cancer studies first..MS studies on the way
Lim et al. MedRxiv doi: https://doi.org/10.1101/2021.06.05.21258311.Individuals with lymphoid cancers have an increased mortality risk from COVID-19. Paradoxically, this population is least likely to be protected by SARS-CoV-2 vaccination as a result of disease- or treatment-related immunosuppression. This early interim analysis details the antibody responses to first- and second- SARS-CoV-2 vaccination with either BNT162b2 (Pfizer-BioNTech) and ChAdOx1 (AstraZeneca), in 129 participants. Responses are compared to those obtained in healthy volunteers. Participants received either ChAdOx1 (AstraZeneca) or BNT162b2 (Pfizer-BioNTech) vaccines, ten-twelve weeks apart. The key findings of this interim analysis are first, 61% of participants who are vaccinated during or within 6 months of receiving systemic anti-lymphoma treatment, do not have detectable antibodies despite two doses of vaccine.
Now we have got to say that the people were largely not treated with ocrelizumab and not all were treated with anti-CD20 but it is an indication….that is coming. Trust me I know it’s coming.
Finally, whilst there was no difference in (the poor) antibody responses between BNT162b2 and ChAdOx1 in cancer patients, BNT162b2 induces 11-fold higher antibody responses than ChAdOx1 after the second dose in healthy donors. This highlights the critical need to identify an alternative strategy against COVID-19 for those undergoing systemic anti-lymphoma treatment.
This shows me nothing that I dont know we have seen this in other studies
Moving forward I hope there are enough cases where people do make a response so that when vaccination part 3 comes around, which it probably will, we can make an informed decisions. Likewise let’s remember many places have not had vaccines.. Maybe we will find it is not important and it is all T cells, if so a whole virus vaccine would be useful to give nucleocapsid responses in addition to Spike responses. But my prediction will be the B cell repopulators will be more likely to respond (and ideally should be measured) and we will need to see if a delay would facilitate this. There are also alternatives and that will be to be give an anti-SARS-CoV-2 response.
General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust.