The King has not left the Building and is Back Again within a Week..Antibody responses on anti-CD20 and delays


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.

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  • In Norwegian the German name is translated to Konge not King 🙂 King is English. 🙂 Yes the MS competencesentre in Bergen at Haukeland Universityhospital ,- they have given that information through the Corona year, and because also rituximab was considered to worsen your ability to handle Covid19 they were testing longer periodes between injections, if your MS seemed in control.
    I have the impression that Haukeland in normal gives rituximab for every 6 months, for many years of treatment. In Oslo (our neurologist) they mentioned that they expected to give rituximab every 6 months for a few years and then stop because they expected longterm effect and medication was then not needed for years. Anyone knowing anyother place they have that experience?

  • I have a question. I keep seeing ‘You will get a response if you delay’. But let’s say we delay, give the vaccine, wait a month. Give the next infusion. Will I end up mounting a better response after that infusion that I would have otherwise? Does getting a response mean it will persist after I resume treatment?

    • No we cannot say you will get a response, some people won’t.
      We can’t say for definite what happens but once plasma cells are formed ocrelizumab is not going to get rid of them so you would expect that the response persists

          • In my country (the Netherlands) both tests are available.

            How many weeks after my third jab should I do the Elispot test to have the best chance to see if my T-cells are working?

            The Elisa test showed a big negative result on antibodies.

            Thanks and regards

  • I’ve been on both. I was in one of the trials for ofatumumab. I did pretty well for the first 18 months (much better than I had been Techfidera but still had 1 smallish relapse). At the end of 18 months I was told the trial was done and my site was not included in the open label phase. Right at this point I also started to have another relapse that turned into a really bad one. 3 months after my last dose of ofatumumab I started on Ocrilizumab. I did badly into the 12 month mark (3rd round) on it and have been fantastic since (like so good that I just ran my first marathon).

    I personally don’t beleive they are the same. Given my experience I also don’t think a 2 year study is enough. What I would like to see is some really solid restrospective work with real life data comparing patient outcomes over a much longer time frame, like 5 years. We need this for all treatments. I want to see drug comparisons including safety profiles over long periods of time. I personally would be happy to open my medical records for this type of study. I beleive lots of patients would if we were allowed to do so (very complicated in Canada where I am). Right now from a patients perspective there is very little meaninful data helping us make educated decisions about what drug is best for our situation.

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