Sophie Caillard, Olivier Thaunat, Ilies Benotmane, christophe masset, Gilles Blanchodoi: https://doi.org/10.1101/2021.09.03.21262691
Third courses and Bossters are going to appear soon. We know that people who take fingolimod and ocrelizumab make a relatively poor response, but I think people offered a boost will benefit protection wise.
However we have concern about fingolimod and ocrelizumab and the people who have not responded after the first two cycle.
First thing first is the booster should be an RNA vaccine (Pfizer/Moderna) not Astrazeneca.
Not what is going to happen We dont know about fingolimod as it is rather MS unique.
However so far I have seaen a few cases of two dose non responders get a third jab and there was largely no response again.
This has been seen in kindney transplatation where the drugs are different. Here is a study of four doses
Approximately 50% of patients who failed to respond after the second dose, seroconverted after a third booster dose. However, despite the fact that a three-dose scheme of vaccination allows reaching a seroconversion rate of up to ~65% of people,
If you made a poor response third dose you can up it with a forth……however it says patients who remain non-responders after the third dose (< 1 BAU/ml) are unlikely to respond to a fourth boost (data not shown) and may instead benefit from pre- or post-exposure infusions of monoclonal antibodies as an alternative prophylactic option
So I think it says we need to try and get some movement on third doses. Can we optimize this chance. I think we can.
P.S. Here is the letter from NHS England to all GPs and NHS trust chief executives regarding the 3rd dose of the vaccine. This covers all pwMS on immunosuppressive and immunomodulatory therapies.C1399-Updated-JCVI-guidance-for-vaccinating-immunosuppressed-individuals-with-third-primary-dose