So in the race to get there quickly, we are seeing the case reports surface of people on ocrelizumab, not developing an antibody response. Below, we see a paper of 4 people…and they report “the first data“..which as ever is never the first data….They say the response is blunted…then say “data are urgently needed to confirm and expand these preliminary results”…but the data were published well over two months ago and reported over three months ago in over ten times more people before the first report was submitted. We have seen another 40+ more (Karussis) and their are others including our own.
However, in this report people did make a response (above 33 antibody units was considered positive). Indeed 2/4 people did, but the response wasn’t a strong response. But it was a response. At 2 weeks after the first does the level was about 200 antibody units in health care workers, which is when there is high protection from the vaccine and 2000 antibody units after the second dose. Because the vaiants of concern often require more antibody to neutralize this the higher levels the better. One person with MS made 175 antibody units after the second dose and had delayed infusion and got their vaccine after about 6 months and they also had detectable B cells in the blood. These people are the gold dust that will tell us what to do…..
It seems that the French approach favoured by some is going to give immunosuppressed people a third dose of vaccine. “The patients who are eligible for the third dose will receive either the Pfizer-BioNTech or Moderna vaccine. They should receive the third dose four weeks after the second, or as soon as possible if it has already been more than four weeks since their second dose. I am not calling the shots, but the Moderna Vaccine gives higher antibody levels than Pfizer and one has to ask is this good after bad without learning. It may give a T cell boost but if you want T cells then maybe you want them to target other targets in addition to Spike such as nucleocapsid…but the approved vaccines in West are all against Spike. Would it be worth waiting until B cells are recovering? But in effect it adds at least another month on the process, but the data show that waiting up to 5 months to start vaccine still results in lack of seroconversion in many people. If we can collate all the data a pattern hopefully will emerge and hopefully people will present the data so that it can be collated.. I think I can see something already emerging when looking across condidtions, but it is better to be informed than guess. In the UK if we have a third dose what will it be?
I don’t know, but I expect we will all get one in due course.
Preliminary evidence of blunted humoral response to SARS–CoV–2 mRNA vaccine in multiple sclerosis patients treated with ocrelizumab.Gallo A, Capuano R, Donnarumma G, Bisecco A, Grimaldi E, Conte M, d’Ambrosio A, Coppola N, Galdiero M, Tedeschi G.Neurol Sci. 2021 Jun 15. doi: 10.1007/s10072-021-05397-7
Objectives: Several concerns regard the immunogenicity of SARS-CoV-2 vaccines in people with multiple sclerosis (pwMS), since the majority of them is treated with immunomodulating/immunosuppressive disease modifying therapies. Here we report the first data on the humoral response to mRNA SARS-CoV-2 vaccine in a case series of 4 pwMS treated with ocrelizumab (OCR) as compared to a group of healthy subjects (HS).
Methods: We collected serum samples at 0, 14, 21 days after the first dose and 7 days after the second dose of BNT162b2-mRNA-Covid-19 vaccine from 55 health-care workers and 4 relapsing pwMS on OCR, with no history of Covid-19 infection. Sera were tested using the LIAISON®SARS-CoV-2 TrimericS-IgG assay (DiaSorin-S.p.A.) for the detection of IgG antibodies to SARS-CoV-2 spike protein. The anti-spike IgG titers were expressed in Binding Antibody Units (BAU), an international standard unit.
Results: At baseline all subjects were negative for anti-spike IgG. Seven days after the second dose of vaccine all HS mounted a significant humoral response (geometric mean 2010.4 BAU/mL C.I. 95% 1512.7-2672) while the 4 pwMS showed a lower response (range <4.81-175 BAU/mL).
Discussion: Humoral response to BNT162b2-mRNA-vaccine in pwMS treated with OCR was clearly blunted. Further data are urgently needed to confirm and expand these preliminary results and to develop strategies to optimize the response to SARSCoV-2 vaccines in pwMS on OCR.
However if you do not make a B cell response can you be given one.
STORM Chaser is a just failed trial, which suggests you can. As you know you have to give an outcome and the trial failed to meet its endpoint. This has happened with many antibodies. They looked at people with recent contact with infected people and asked if you give people a neutralizing antibody cocktail do you stop symptomatic infection. The answer was it wasnt good enough, but do it in people how do not have an activie infection and have been infection free for a week and the answer is 92% protection. Luckily they have other trials to try and see if this is the case.
Here are the results. Seems companies are learning that they dont need academics to publish their work
AZD7442 is a combination of two LAABs – tixagevimab (AZD8895) and cilgavimab (AZD1061) – derived from B cells donated by convalescent patients after SARS-CoV-2 virus, the human monoclonal antibodies bind to distinct sites on the SARS-CoV-2 spike protein and were optimised by AstraZeneca with half-life extension and reduced Fc receptor binding. The half-life extension approximately triples the durability of its action compared to conventional antibodies and could afford six to 12 months of protection from COVID-19 following a single administration.
So there you go anti-CD20 and AZD7442…P.S. Im not a
Coi multiple byt none relevant
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