Get ready for the flood-gates on papers about poor vaccine responses and B cell inhibition… The Redcoats are coming.

The Regulars are Coming Out_April 19th, 1775 | History and Hobby
This saying was said (Paul Revere) when the British (soldiers wearing red) arriving in USA

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: 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.

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  • In British Columbia, Canada we were all scheduled for a 12 weeks interval for Moderna and Phiser(sic) as we didn’t have enough vaccine. Now it seems we do have enough and we are now at an 8 week interval. Until we run out again then we will be back to 12 week interval I suppose. So what difference will it make with Ocrevus treatment? Nothing as they are not checking anyone to see if there is an antibody response. It’s like a sad Monty Python skit. Right nothing here folks, carry on. So we, those on these drugs, don’t matter. Meanwhile got the vaccine, even if it likely will not work, as will likely need some kind of proof if I ever want to cross a border.

    • None I think if the time interval between infusion and vaccine and less than 5 months I think 2/3 will not make an antibody response, but I will change my post thanks for the update

  • so people on Ocrevus should go back to shielding then?

    little vaccine response, beta =60% more transmissable, R is well over 1 in most places, more hospitalsations, idiots going around as if they is already over……

    Christ, what next!!!

    And if this comes to pass, are neuros supposed to inform their patients of this?

  • Don’t forget about me with my positive antibodies post Pfizer. It’s not all bad news anti CD20-ers! (Although it certainly does feel like it most of the time reading this)

    • Yes there are a number of people who do respond and the question is we need to ask is how can we push things in favour of this. We know the MS Margaret Keenan responded but they delayed infusion to get vaccinated. Is this the answer? Dr Ruth has a different idea. Did they have B cell repopulation?

  • 13 weeks post ocrevus infusion (ms society said 12) yet no antibodies after pfizer fully vaccination. infuriating! where are the t-cell studies? why no clinical data released from neuros on extent of anti cd20 patients fully vaxxed yet breakthrough covid? where are the suggestions other than “be very careful” or shield? this question also relates to prof G’s recent post about giving (not fully trialed) information when a patient is faced with poor outcome. why no push for prophylaxis monoclonal antibody cocktail for anti cd20 tx MS (and other immune-compromised) folk? we need people like prof G to say yea or nay on that since Regeneron data released albeit in press release form (like everything else these days! ). what about some guidance on delay on Ocrelizumab until b cells repop? i thought i read from prof G once that it takes 3 years to repop but i could be mistaken. needless to say, 3 years would be quite disappointing (and makes me wonder about need for infusion every 6 months).

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