MSCOVID19 more of the Same Old, Same Old


So it is becoming more and more clear that some form of T cell response is made after COVID-19 infection even if you dont make a B cell repsonse if you have been treated with anti-CD20 and this is reflected in what we see after vaccination.

What are we going to do with this information….it seems like the answer is nothing…at the moment.

Iannetta M, Landi D, Cola G, Malagnino V, Teti E, Fraboni D, Buccisano F, Grelli S, Coppola L, Campogiani L, Andreoni M, Marfia GA, Sarmati L. T-cell responses to SARS-CoV-2 in multiple sclerosis patients treated with ocrelizumab healed from COVID-19 with absent or low anti-spike antibody titers. Mult Scler Relat Disord. 2021 Jul 21;55:103157.

Results: Five patients with MS receiving ocrelizumab treatment for at least 1 year and recovered from SARS-CoV-2 infection were enrolled in the study. Despite the absence or the very low concentration of anti-Spike antibodies, a T-cell response was detectable in all the five MS patients. These results are in accordance with the marked reduction of peripheral B-lymphocyte absolute counts induced by ocrelizumab, that, conversely, did not affect peripheral blood T-lymphocyte subset absolute and relative counts and CD4/CD8 ratio.Conclusions: The detection of specific T-cell responses to SARS-CoV-2 in patients receiving B-cell depleting therapies represents a useful tool to improve the diagnostic approach in SARS-CoV-2 infection and to accurately assess the immunological response after natural infection or vaccination.

This sounds like good news again that there is a T cell response (PHA is a non-selective stimulator of T cells used as a control) despite a reduced B cell response

Habek M, Jakob Brecl G, Bašić Kes V, Rogić D, Barun B, Gabelić T, Emeršič A, Horvat Ledinek A, Grbić N, Lapić I, Šegulja D, Đurić K, Adamec I, Krbot Skorić M. Humoral immune response in convalescent COVID-19 people with multiple sclerosis treated with high-efficacy disease-modifying therapies: A multicenter, case-control study. J Neuroimmunol. 2021 Aug 16;359:577696.

A few days ago we heard the view that the poor response of fingolimod to vaccine was surprising given people who were naturally infected, where more likely to make a response. In this other report we see this again 2/6 were negative (66% positive) after fingolimod again 29/42 negative (31% positive) after ocrelizumab, 0/3 negative (100% positive) with Ublituximab (Too few to make comment). 1/44 healthy controls were negative (98% positive)

Pérez CA, Zhang GQ, Li X, Huang Y, Lincoln JA, Samudralwar RD, Gupta RK, Lindsey JW. COVID-19 severity and outcome in multiple sclerosis: Results of a national, registry-based, matched cohort study. Mult Scler Relat Disord. 2021 Aug 16;55:103217. Background: Risk factors associated with coronavirus disease 2019 (COVID-19) severity in patients with multiple sclerosis (MS) have been described. Recent improvements in supportive care measures and increased testing capacity may modify the risk of severe COVID-19 outcome in MS patients. This retrospective study evaluates the severity and outcome of COVID-19 in MS and characterizes temporal trends over the course of the pandemic in the United States.Methods: We conducted a comparative cohort study using de-identified electronic health record (EHR) claims-based data. MS patients diagnosed with COVID-19 between February 2, 2020 and October 13, 2020 were matched (1:2) to a control group. The primary outcome was a composite of intensive care unit (ICU) admission, mechanical ventilation, and/or death. Results: A total of 2,529 patients (843 MS and 1,686 matched controls) were included. Non-ambulatory and pre-existing comorbidities were independent risk factors for COVID-19 severity. The risk for the severe composite outcome was lower in the late cohorts compared with the early cohorts. Conclusions: The majority of MS patients actively treated with a disease-modifying therapy (DMT) had mild disease. The observed trend toward a reduction in severity risk in recent months suggests an improvement in COVID-19 outcome.

This suggests that care for people with COVID-19 now is better than at the beginning of the pandemic, so this is good news for all of us destined to get infected in the future. If you have been vaccinated this will be another factor for a better outcome

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  • Thanks MD. Looking forward to clinical data on how vaccinated anti cd20 treated patients actually deal with infection.

  • Thanks MD. As a Barts patient who has had ocrelizumab since Feb 2020 and recovered from Covid earlier this year this is heartening news that we may have some response rather than none. Thanks for your continued updates

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