#MSCOVID19 Learning from 4 Jabs


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.


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  • As usual, I am confused. If no B cells (due to anti-cd20) how does someone seroconvert? Presumably in this cited study those that did seroconvert had some degree of B cell? As an aside, is it reasonable to assume that the T cell response will be even more elevated after 3 (or more) jabs regardless of antibodies? If indeed so that would be helpful, no? In any event, the (Regeneron) monoclonal cocktail is a good idea if it is durable but I have read on this blog (comments) that it is effective for perhaps only 30 days. Another formulation (yet to be approved?) possibly 12 months prophylaxis durability, which would of course be welcome. Unfortunately limited supplies all the way around from what I’ve read.

  • Hi – Wondered why people are differentiate between the two jabs as either 3rd dose for immunosuppressed or booster jab for the elderly etc. Is the dose size different, or is just a nomenclature thing?

    Interesting findings, although not entirely surprising…. If I was on fingolimod, I think I’d be wanting out by now, hope these people are getting options and are being properly informed

  • MD – what is the best way to check your current level of covid ‘protection’. The Roche antibody test? is their a test that HCP can run? in my case, i had doses 1 and 4.5 months after ocrevus infusion, then caught covid month 5.5. I am fully recovered so that is effectively dose 3. I’m trying to decide whether to bother with dose 4

  • After 6 years on fingolimod I made no antibodies after two shots of Pfizer, 6 weeks apart. As I am preparing for a booster jab, I am wondering whether it makes sense to try and get Moderna next time? Would that possibly increase my chances of making antibodies? And after how many months does a booster make sense? I live in Germany where the overall recommendation is after 6 months.

  • I’m on fingolimod and didn’t seroconvert after two doses of Moderna, but I just found out this week that I did seroconvert after my third dose, which is a tremendous relief. Fingers crossed some other readers have good responses to third doses as well!

  • Hello to all. 37 year male fingolimod user here with no antibodies after 2 doses of Pfizer (14.23 BAU/ml using ELFA test method). Today I had my 3rd dose of Pfizer here in Greece, after almost 4 months. I am not too hopeful but maybe some antibodies will rise from their deep sleep, who knows?

    However, I really don’t know if I should be tested again for seroconversion and after how many days.. I will keep wearing my KN95 mask, using sanitizer and wash my hands regularly and also avoiding any crowded places.

    Stay safe y’all!

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