I am still waiting for the avalanche of vaccine responses…we continue to chug through ours but as the majority of samples are from people with anti-CD20, we already know what will happen. We have seen it published with the Pfizer vaccine, we will see it with the Astra-zeneca vaccine and we will see it with other vaccines too. We have seen it with ocrelizumab, we have seen it with rituximab. We have seen it with cancer, arthrtis and other conditions and MS will be no different. On the positive side, we have seen that T cell responses can be made, we will soon see it in MS I suspect, and also that whilst people do get infected…the important point is that disease is milder. This is immunology 101 in action and shows why it is a good reason to be vaccinated.
The reason that it was considered likely immunosuppressed people would respond to the Astrazeneca vaccine (as stated in the Green Book) was because of Ebola studies in people, some of which had HIV. However, when you looked there were less than 5% of people and none of the subjects had AIDS. So in this study of so called immunosuppressed people who had HIV infection and vaccine what did they find. So it comes as no surprise to me most people made a T and B cell response. It has to be said that no-one had AIDS and no-one had T cells in the alemtuzumab range and CD4 count at enrolment was 694·0 cells per μL (IQR 573·5–859·5). Unsurprisingly when “Compared with participants without HIV, they found no difference in magnitude or persistence of SARS-CoV-2 spike-specific humoral or cellular responses (p>0·05 for all analyses)”. https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(21)00103-X/fulltext
However, the drip drip drip maybe starting to trickle. However some good news for people on fingolimod, this Milan study is not quite as bad as the Israeli study reports. They report 10/16 had a positive response, however, I have to say it looks like 2 of those had a response that was a bit pants, so maybe 50% gave a response. So more like I thought was going to happen as people with fingolimod getting covid were seroconverting. Bigger N =number is needed
Now to the CD20 depleted. Again suggsting a inhibition they say no trend but maybe if your CD19+ B cells are over 1.5% of the population or you have waited over 5.3 months then below this you have 1/9 positive (11%) and over then 5/7 (71%) positive, so maybe worth a test and a wait to maximize your response. This is why we need more data you help inform you to make the best choice. You could ask are there any people that have waited for 6.6 months and not had a postive response?
Serological response to SARS-CoV-2 vaccination in multiple sclerosis patients treated with fingolimod or ocrelizumab: an initial real-life experience. Guerrieri et al. J Neurol. 2021 Jun 26. doi: 10.1007/s00415-021-10663-x. Online ahead of print.
Background: Recent observations suggest a lack of humoral response after SARS-CoV-2 vaccination in multiple sclerosis (MS) patients treated with fingolimod or ocrelizumab
OBJECTIVES: To assess serological response to SARS-CoV-2 vaccination in MS patients receiving these disease-modifying treatments (DMTs) in a real-life setting. (Not sure what other setting we are talking about as there are no major trials solely in MS)
Methods: Retrospective clinical data collection from MS patients followed at San Raffaele Hospital MS Centre (Milan, Italy). All patients treated with fingolimod or ocrelizumab who had received a complete anti-COVID-19 vaccination course, with no clinical history suggestive of previous SARS-CoV-2 infection and with an available post-vaccination serological assay obtained at least 14 days after vaccination completion were considered for the study.
Results: We collected data from 32 MS patients, 16 treated with fingolimod and 16 receiving ocrelizumab. Among the fingolimod group 10 patients (62.5%) had a positive serological response after vaccination and among ocrelizumab-treated patients a positive serological test was found in six cases (37.5%). No relation between serological response and clinical features (i.e., treatment duration, time between vaccination and last treatment dose, and white blood cells count) was identified (Not surprsing because the time between vaccination and infusion was less than).
Conclusions: Our initial real-life experience suggests a variable antibody production in MS patients receiving these DMTs. At present, there are no sufficient data to do not recommend anti-SARS-CoV-2 vaccine in these patients.