#MSCOVID19 BartsMS and Wales Vaccine (Cello) Responses

#

This informaton is online but DrRuth is on Holidays and so she said it was OK if I gave you my biased view of the data. This follows the vaccine response of nearly 500 people with MS .

Emma C Tallantyre, Nicola Vickaryous, Valerie Anderson, Aliye Nazli Asardag, David Baker, Jonathan Bestwick, Kath Bramhall, Randy Chance, Nikos Evangelou, Katila George, Gavin Giovannoni, Leanne Grant, Katharine E Harding, Aimee Hibbert, Gillian Ingram, Meleri Jones, Angray S Kang, Samantha Loveless, Stuart J Moat, Neil P Robertson, Klaus Schmierer, Sita Navin Shah, Jessica Simmons, Matthew Upcott, Mark Willis, Stephen Jolles, Ruth Dobson. COVID-19 vaccine response in people with multiple sclerosis. doi: https://doi.org/10.1101/2021.07.31.21261326

So if you have not had the jab yet…ask why not?

But maybe you can learn from the messages

ProfK tweeted ” If your violin looks like a cello sitting plump on the floor, you may have to face the music”

What does this mean?

No…. he has passed his drugs test and this not some rambling of a mad person. It is not some form of German Slang made up by ProfK to confuse us. Furthermore…yes it has nothing to do with ProfKs love of Wagner and DrRuths instrument of choice.

We all like a bit of cello music! Don’t we?

If you don’t……Listen to some Swedish Cellists…. I bet Jacqueline du Pré would have approved:-)

p.s. yep work out the original and enjoy too.

However on the vaccine front……You dont want the cello!

This is what ProfK tweeted

Image

Its called a violin plot.

You can see there are two cellos….Anti-CD20 and fingolimod.

I think they look more like Lutes and says….you have paid your loot to get a vaccination turkey:-(This is because it says fingolimod and anti-CD20 blocks the generation of a vaccine antibody response.

I would rather you have reasonable sized hips, well proportioned thighs and slender calves and feet…..Why?

Because it means you have made a good vaccine response.

The 1 to 3 means the level of antibody response after vaccine. 1 = poor and 3 = good. The wider the vaccine plot the more people have achieved the response. So having big hips is an advantage here. As you can see alemtuzumab DMF and cladribine have a much better figure:-)

It says that if you took ocrelizumab/rituximab/ofatumumab (most data based on ocrelizumab) you don’t make a good antibody response after vaccination and this is also the case for fingolimod.

This is sad news if you are on these treatments, but it is explanable.

Already we know that people taking ocrelizumab are likely to make a potentially protective T cell response, based on other peoples work.

Of the 58 vaccine naïve baseline samples, 6 (10.3%) were seropositive and 52 (89.7%) seronegative
for SARS-CoV2 so most people were being careful to not get infected.

For the other DMT most people seroconverted to become positive.

However the data said that people using astrazeneca vaccine had fat calf’s

So it indicates that the AZ induces lower levels of antibodies than the RNA vaccines like pfizer. To me….. if Boosters are going to happen then is says something. If you took ocrelizumab and fingolimod it does not seem to matter what vaccine you got they were both pretty bad, in terms of generating an antibody response

Can we optimize the vaccine response in the people making a poor vaccine antibody response? The data/paper says no. But I dont believe this….but it is not going to be straight forward. However, the question we have to ask is, is this worth it? ProfK says “you may have to face the music” and accept this potential problem.

Tallantyre et al. COVID-19 vaccine response in people with multiple sclerosi .doi: https://doi.org/10.1101/2021.07.31.21261326

Objective To investigate the effect of disease modifying therapies on serological response to SARS-CoV2 vaccines in people with multiple sclerosis

Methods 473 people with multiple sclerosis from 5 centres provided one or more dried blood spot samples and questionnaires about COVID-19. Information about disease and drug history was extracted from their medical records. Dried blood spots were eluted and tested for antibodies to SARS-CoV2 receptor binding domain. Seropositivity was expressed according to validated cut-off indices. Antibody titers were partitioned into tertiles using data from people on no disease modifying therapy as a reference. We calculated the odds ratio of seroconversion (Univariate logistic regression) and compared quantitative vaccine response (Kruskal Wallis) following SARS-CoV2 vaccine according to disease modifying therapy. We used regression modelling to explore the effect of factors including vaccine timing, treatment duration, age, vaccine type and lymphocyte count on vaccine response.

Results Compared to no disease modifying therapy, the use of anti-CD20 monoclonal antibodies (odds ratio 0.03; 95% confidence interval 0.01-0.06, p<0.001) and fingolimod (odds ratio 0.41; 95% confidence interval 0.01-0.12) were associated with lower seroconversion following SARS-CoV2 vaccine. All other drug groups did not differ significantly from the untreated cohort. Time since last anti-CD20 treatment and total time on treatment were significantly related with response to vaccination. Vaccine type significantly predicted seroconversion, but not in those on anti-CD20 medications.

Interpretation Some disease modifying therapies carry a risk of attenuated response to SARS-CoV2 vaccination in people with MS. We provide recommendations for the practical management of this patient group.

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

MouseDoctor

24 comments

  • Face and accept the problem of poor (if any) vaccine response if on anti-cd20? It is faced daily. Premature to accept especially if the full extent of covid infection, and particularly long-haul covid remains unclear (despite good faith suggestions by other practitioners that claim low risk/incidence).

  • were not all these studies done in the months before „delta“ was taking over the planet?
    is it now not just for all the same that your antibodies wont really work that efficiently and so we all are more less in the same t-cell boat (cd20s+fingos = all the others?)
    (colleague of mine and his partner were jabbed in jan/feb with pfizer…went on holidays and he told me that he had the coff, dizzyness for more than a week and pain on chest…partner loss of smell for a view days – they did not test as they would have been stuck on an island…but seems antibodies wane quickly…)

    • I disagree delta needs more antibody to deal with it but it is not the same as having no antibody in the people that make it.

      In the absence of a stimulus….antibodies do wane but when you encounter the problem they re-appear

  • what would be good for comparison also are the responses of people on these medications (my particular interest is fingolimod) who have had covid. What sort of response did they mount? If people on, say, Fingolimod do not have higher risks for severe covid than the general population (as has been mentionned in this blog, if I understood it correctly) then they seem to be mounting some sort of response to the virus (as has been argued here also): has this response been quantified by any research yet?

    • Because fingo is MS specific compared to anti-CD20 which is used all over the place then there is alot less data surfacing. One would hope that the makers of fingolimod could send me the answer of what they are doing I saw they were doing a trial of ofatumumab and siponimod.

      If you have had COVID in non MS COVID + 1 Jab = 2 Jabs but possibly th drugs may limit the immunity from COVID infection response

    • That’s a rather sour view, Kit. Might not be your sort of thing but they aren’t poseurs, are classically trained and love this style of music and have been going since 1993, so not a fad. I always had the impression poseur was shorthand for people who are cooler than you are, much as woke seems to be thrown around with abandon these days 🙂
      Each to their own.

  • Another Apocalyptica afficianado.
    Could we love you even more?
    All the boys signed our daughter’s viola when we were at our 2nd Apo concert…she was already showing signs of Pediatric Onset MS at that point, but not yet diagnosed.

    • Lovely story, they sound like great guys. Best wishes to your daughter. The Metallica DVD with the San Francisco symphony orchestra (S&M) is great too and well worth a watch. Interestingly, it was orchestrated and conducted by Michael Kamen, who also had MS and is sadly no longer with us.

  • “I bet Jacqueline du Pré would have approved:-)”

    Jacqueline du Pre was regarded as one of the greatest cellists. Her career was cut short by multiple sclerosis, which forced her to stop performing at the age of 28; she died 14 years later at the age of 42 in 1987.

  • I read the pre-print and then spent a good few (slightly self-orientated) mins trying to work out which of the dots on the scatter graphs might be me 😂. I had the first jab less than a week short of 7 calendar months after the previous dose of ocrelizumab so don’t know which result group I fall into either. Or maybe I was the dividing line….

    It’s the first study I’ve taken part in other than MS Registry qus so I’ve found it really interesting to see the first set of results come out. Best wishes to the research team for the continuing work.

    • Thanks for participating……The issue could be that you may not have been analysed yet, we still have more bloods to analyse

      • Ah. I hadn’t considered that. I was one of the early returns (including a baseline naive in late Jan) and had my jabs in late Jan and Feb so had assumed mine would be in this lot.

        I’ll keep watching for the next set.

        • I also may depend on your treatment, we focused on ocrelizumab as a predicted problem child, not sure about the welsh cohort

  • I think it was mentioned there may be a more robust immune response to heterologous vaccines i.e. seasonal influenza and pneumococcal vaccines. Might we see the same with SARS CoV-2 by adding variants in the vaccine.

By MouseDoctor

Translate

Categories

Recent Posts

Recent Comments

Archives