Getting protection without knowing it due to CD20 treatment

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If you have been on long-term anti-CD20 treatment you probably won’t have made a covid 19 vaccine antibody response. Furthermore, some of you may have reduced immunoglobulin levels due to long-term B cell repletion and you may be supplemented with intravenous immunoglobulin. Well this could mean that you are getting an anti-SARS-COV-2 antibody response because intravenus immunoglobulins are made from donors and these donors will be getting vaccinated or catching COVID-19, the intravenous immunoglobulin to limit infection may protect you from COVID-19

SARS-CoV-2 Neutralization in Commercial Lots of Plasma-derived Immunoglobulin.Andreas Volk, Caroline Covini-Souris, Denis Kuehnel, Christian de Mey, Juergen Roemisch, Torben Schmidt MedRXiv doi: https://doi.org/10.1101/2021.08.13.456066

Introduction: Patients suffering from primary or secondary immunodeficiency face times of increased insecurity and discomfort in the light of the raging Covid-19 pandemic, not knowing if and to what extend their comorbidities impact a potential Covid-19 course of disease. Furthermore, recently available vaccination options might not be amenable or effective for all patients of this heterogeneous population. Therefore, these patients often rely on passive immunization with plasma-derived, intravenous or subcutaneous immunoglobulin (IVIG/SCIG). Whether the ongoing Covid-19 pandemic and/or the progress in vaccination programs lead to increased and potentially protective titers in plasma-derived immunoglobulins (Ig) indicated e.g. for humoral immunodeficiency remains a pressing question for this patient population. Purpose: Here we investigated SARS-CoV-2 reactivity of US plasma-derived IVIG/SCIG products from the end of 2020 until 06/2021 as well as in convalescent plasma (CP) from 05/2020 to 08/2020.

Results: CP donations presented with a high variability with regards to anti-SARS-reactivity in ELISA as well as in neutralization testing. While approximately 50% of convalescent donations were none/low neutralizing, approximately 10% were at or above 1000 IU/ml. IVIG/SCIG lots derived from pre-pandemic plasma donations did not show neutralizing capacities of SARS-CoV-2. Lots produced between 12/2020 and 06/2021, entailing plasma donations after emergence of SARS-CoV-2 showed a rapid and constant increase in anti-SARS-CoV-2 reactivity and neutralization capacity over time.

Conclusions: SARS-CoV-2 reactivity and neutralization capacity in IVIG/SCIG produced from US plasma rapidly and in part exponentially increased in the first half of 2021. In summary, the data support rapidly increasing levels of SARS-COV-2 antibodies in IVIG/SCIG products implicating that a certain level of protection could be possible against COVID-19 for regularly substituted PID/SID patients.

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