It is clear people with MS make a T cell response even on anti CD20. Many make an anti spike antibody response but tend to make less neutralising response against the receptor binding domain of spike..
What does it mean?….I think it means you are at a greater risk of symptomatic covid 19 if you are on anti CD 20 and don’t make an antibody response. I think even in those that do….. the antibody level is reduced. This may determine how long the vaaccine effect lasts
Why say this. Well protection from infection associates with high antibody levels and these drop within a few months from vaccination and so we are seeing infections in double jabbed people.on the increase.
The good news is that protection from hospitalisation and death seems to last much longer than protection from infection. Will the new variants you need more anti-Wuhan strain antibody to block them
Booster jabs will help this as they raise antibody levels.
Sadly I don’t see that the booster vaccine antibody response will be that much better for the B cell response. However they may boost T cell response.
So what will happen with anti CD20? We have to wait and see. Based on people with natural infections there is possibility of worse course, so remain careful.
I suspect that after a few days of symptoms your T cells and any antibodies that you can make will kick in and get rid fot eh virus in most people
Discordant humoral and T cell immune responses to SARS-CoV-2 vaccination in people with multiple sclerosis on anti-CD20 therapy
Sachin P. Gadani, Maria Reyes-Mantilla, Larissa Jank, Samantha Harris, Morgan Douglas, Matthew D. Smith, Peter A. Calabresi, Ellen M. Mowry, Kathryn C. Fitzgerald, Pavan Bhargavadoi: https://doi.org/10.1101/2021.08.23.21262472
Background Sphingosine-1-phosphate receptor (S1P) modulators and antiCD20 therapies impair humoral responses to SARS-CoV-2 mRNA vaccines. Whether disease modifying therapies (DMTs) for multiple sclerosis (MS) also impact T cell immune response to vaccination is unknown.
Methods In 101 people with MS, we measured humoral responses via an immunoassay to measure IgG against the COVID-19 spike S1 glycoprotein in serum. We also measured T cell responses using FluoroSpot assay for interferon gamma (IFN-γ) (Mabtech,Sweden) using cryopreserved rested PBMCs and then incubated in cRPMI with 1µg/ml of pooled peptides spanning the entire spike glycoprotein (Genscript, 2 pools; 158 peptides each). Plates were read on an AID iSpot Spectrum to determine number of spot forming cells (SFC)/106 PBMCs. We tested for differences in immune responses across DMTs using linear models.
Findings Humoral responses were detected in 22/39 (56.4%) participants on anti-CD20 and in 59/63 (93.6%) participants on no or other DMTs. In a subset with immune cell phenotyping (n=88; 87%), T cell responses were detected in 76/88 (86%), including 32/33 (96.9%) participants on anti-CD20 therapies. AntiCD20 therapies were associated with an increase in IFN-γ SFC counts relative to those on no DMT or other DMTs (for antiCD20 vs. no DMT: 425.9% higher [95%CI: 109.6%, 1206.6%] higher; p<0.001; for antiCD20 vs. other DMTs: 289.6% [95%CI: 85.9%, 716.6%] higher; p<0.001).
Interpretation We identified a robust T cell response in individuals on anti-CD20 therapies despite a reduced humoral response to SARS-CoV-2 vaccination. Follow up studies are needed to determine if this translates to protection against COVID-19 infection.
Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.