#MSCOVID19 On anti-CD20. You make a T cell response, just like I suggested you would


Get ready its starting!. The trickle increases, today we have a CD20 and T cell paper surfacing into the public eye, will it be the first published I suspect not, but data from 20 people surface. We had done many more than this weeks ago, but people will say if I don’t get it out, soon who will care. Anyway this paper says if you have CD20 you can pick up a response in many people but it is blunted. Neutralizing antibodies, or should I say those more likely to be neutralizing (stop infection) are less common. If you thinking of cycle 3. I guess one can optimize chance of responding. But will it be worth trying as a T cell response is present to give you protection. This seems better when people have a reduced B cell response.

Sokratis A. Apostolidis et al. Altered cellular and humoral immune responses following SARS-CoV-2 mRNA vaccination in patients with multiple sclerosis on anti-CD20 therapy. MEDRXIV doi https://doi.org/10.1101/2021.06.23.21259389

SARS-CoV-2 mRNA vaccination in healthy individuals generates effective immune protection against COVID-19. Little is known, however, about the SARS-CoV-2 mRNA vaccine-induced responses in immunosuppressed patients. We investigated induction of antigen-specific antibody, B cell and T cell responses in patients with multiple sclerosis on anti-CD20 (MS-aCD20) monotherapy following SARS-CoV-2 mRNA vaccination. Treatment with aCD20 significantly reduced Spike and RBD specific antibody and memory B cell responses in most patients, an effect that was ameliorated with longer duration from last aCD20 treatment and extent of B cell reconstitution. In contrast, all MS-aCD20 patients generated antigen-specific CD4 and CD8 T-cell responses following vaccination.

However, treatment with aCD20 skewed these responses compromising circulating Tfh responses and augmenting CD8 T cell induction, while largely preserving Th1 priming. These data also revealed underlying features of coordinated immune responses following mRNA vaccination. Specifically, the MS-aCD20 patients who failed to generate anti-RBD IgG had the most severe defect in cTfh cell responses and more robust CD8 T cell responses compared to those who generated anti-RBD IgG, whose T cell responses were more similar to healthy controls. These data define the nature of SARS-CoV-2 vaccine-induced immune landscape in aCD20-treated patients, and provide insights into coordinated mRNA vaccine-induced immune responses in humans. Our findings have implications for clinical decision-making, patient education and public health policy for patients treated with aCD20 and other immunosuppressed patients.

In this study, they analyzed a group of people with MS to evaluate the effect of aCD20 therapy on SARS-CoV-2 mRNA vaccine responses. Although most MS patients treated with aCD20 (MS-aCD20) made detectable Spike binding antibodiesm 50% made detectable Receptor Binding Domain (RBD) antibodies, antibody titers were lower and delayed compared to healthy control subjects. In contrast, CD8 T cell responses were more robust in MS-aCD20 patients especially following the second vaccine dose. (This is good news as these will be the main vaccine defence)

T1 background T2 after vaccine 1, T3 3 week at vaccine 2, T4 two weeks after vaccine 2 and T5 a month after vaccine 2..

People who had repleted their B cells at the time of vaccination make an antibody response. However, so people who did not could still make an antibody response. If you look at delay between last infusion and response. Then it seems (right below) that there is more of a response (Before 6 months ~3/12 (25%) after 6 months 3/6 (50%) after 8 months 1/1 (100%). More data needed.

However if you look at Spike antibody (above left) there were about 90% of people that made a response but 10*1 is very weak.. I think it is good news but you can have ProfG and his glasses to give his take. How many people on anti-CD20 will get infected and what happens. I am sure recovery is going to be the major response

Immunogenicity of COVID-19 Vaccination in Immunocompromised Patients: An Observational, Prospective Cohort Study Interim AnalysisHaidar, G., Agha, M., Lukanski, A., Linstrum, K., Troyan, R., Bilderback, A., Rothenberger, S., McMahon, D. K., Crandall, M., Enick, P. N., Sobolewksi, M., Collins, K., Schwartz, M. B., Dueker, J. M., Silveira, F. P., Keebler, M. E., Humar, A., Luketich, J. D., Morrell, M. R., Pilewski, J. M., McDyer, J. F., Pappu, B., Ferris, R. L., Marks, S. M., Klamar-Blain, C., Parikh, U. M., Heaps, A., Kip, P. L., Wells, A., Minnier, T., Angus, D., Mellors, J. W.

Objectives: Immunocompromised patients were excluded from COVID-19 vaccine clinical trials. The objectives of the study were to measure antibody responses, levels, and neutralization capability after COVID-19 vaccination among immunocompromised patients and compare these variables to those of immunocompetent healthcare workers. The autoimmune disease were largely arthrits and it was the anti-CD20 who were inhibited 2/5 (40% seroconversion)

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 and are not meant to be interpreted as personal clinical advice. 

About the author



  • Quite complex for a non-expert. May I ask if this is a good or a bad news in terms of protection against covid for those Ocrelizumabers who are already vaccinated or already had the virus, recovered and have no detectable antibodies? Many thanks.

    • Good news, in the fact that there is some level of immunity that should be protective against infection and may well lessen its effects should infection in itially occur.

  • Any encouraging news about fingolimod too? Almost 2 months after my Pfizer 2nd shot, had my antibody test yesterday and unfortunately it’s negative with 14.23 BAU/ml and 0.70 index. I don’t know what the heck these numbers mean, but I understand it’s no good. Keep up the good work!

By MouseDoctor



Recent Posts

Recent Comments