Dr. Marton König (i.e. King in Norwegian) appeared on the blog earlier this week and is back again, to further show you what I have been saying for months. “If you want to optimise your antibody response on ocrelizumab you need to consider a delay”. This study is from the next-door neighbour of rituxiland and shows that if you are on rituximab it is perhaps worth considering a delay of 9 months to get a better response, although this would not guarenteee you a response. Now the problem is this is not ocrelizumab data and its repopulation characteristic is likely to be different. Some people think this information is meaningless because it is off-label. I disagree as it tells us what to expect and what to look for with ocrelizumab.
Humoral immunity to SARS-CoV-2 mRNA vaccination in multiple sclerosis: the relevance of time since last rituximab infusion and first experience from sporadic revaccinations.König M, Lorentzen ÅR, Torgauten HM, Tran TT, Schikora-Rustad S, Vaage EB, Mygland Å, Wergeland S, Aarseth J, Aaberge IAS, Torkildsen Ø, Holmøy T, Berge T, Kjell-Morten M, Harbo HF, Andersen JT, Munthe LA, Søraas A, Celius EG, Vaage JT, Lund-Johansen F, Nygaard GO.J Neurol Neurosurg Psychiatry. 2021 Oct 20:jnnp-2021-327612. doi: 10.1136/jnnp-2021-327612. Online ahead of print.
Introduction: The effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown (“REALLY I GUESS THEY DON’T HAVE COMPUTERS IN NORWAY”:-). Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.
Objective: To characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).
Methods: All pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3-12 weeks after full vaccination, and compared with healthy subjects.
Results: 528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.
Conclusions: Patients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations.
COI None relevant
General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.