During the COVID pandemic the mantra it seems has been “some immunity is better than no immunity” and so for people taking CD20 depleting antibodies being treated on a 6 monthly cycle the likely reality is that you have produced either no anti-SARS-CoV-2 antibodies or very low levels of anti-SARS-CoV-2 antibodies.
Therefore, on balance you are likely to have quite poor immunity against the omicron variant. So you will be at risk of catching the virus if you contact it. This is because high levels of antibodies are needed to offer some protection from becoming infected.
Therefore, you have to rely on the T cell and innate immune response to clear the virus or drugs.
I am sure some T cell response will be of value in many people.
To delay and hope for a B cell repsonse or boost away. That is the question.
I have to say I think we have probably missed the opportunity for the pharma companies to optimise vaccine responsiveness again and soon we will be doing vaccine round four and we will be too slow to do the pilots that can help inform the general roll-out to improve the value of the vaccinations.
However, we are now if a different place as there are some anti-virals that can assist people who do not make immune responses against the virus. There is still an anti-viral antibody that is active even against omicron and now there are anti-viral chemicals available in some countries.
The key to sucess is to recognise that you are infected and have symptoms. You can do this by testing and being aware of the symptoms and if you are positive and have risk factors for a bad time.
Getting access to the anti-virals as soon as possible is key to the successful use of anti-virals
In the USA, a drug has been approved and this is called paxlovid. This is a mixture of two drugs and one of them is called ritonovir. This blocks liver enzymes (CYP3A and CYP2D) that are responsible for breaking down drugs and so it means that the other drug in the combination will work for longer to kill off the virus. The down side is this liver enzyme also breaks down many therapeutic pills and so it means that they will work for longer. A concern could be that this could affect the side effect profile of some drugs.
Now, I would not be so worried, as it probably safer to save you with an anti-viral for a few days at he potential expence of not taking a pill to stop a non-life threatening situation, but what I would say is have a list of the different medications that you are taking and if you are unfortunate to get infected and have risk factors and when you talk to your doctor and health care team and you get offered paxlovid, remember to tell them what you are taking.
So drugs being used in MS studies have this potential so again I say not to worry and importantly chemical MS disease modyfying do not appear to be affected by these particular enzymes
Humoral Immune Response after the Third SARS-CoV-2 mRNA Vaccination in CD20 Depleted People with Multiple Sclerosis.Achtnichts L, Jakopp B, Oberle M, Nedeltchev K, Fux CA, Sellner J, Findling O.Vaccines (Basel). 2021 ;9(12):1470. doi: 10.3390/vaccines9121470.
CD20 depletion is a risk factor for unfavorable outcomes of COVID-19 in people with MS (pwMS). Evidence suggests that protective IgG response to mRNA-based vaccines in B cell-depleted individuals is limited. We studied the seroconversion after the third mRNA SARS-CoV-2 vaccine in B cell-depleted pwMS with limited or no IgG response after the standard immunization. Sixteen pwMS treated with ocrelizumab or rituximab received a third homologous SARS-CoV-2 mRNA vaccine, either the Moderna mRNA-1273 or Pfizer-BioNTech’s BNT162b2 vaccine. We quantified the response of IgG antibodies against the spike receptor-binding domain of SARS-CoV-2 four weeks later. An antibody titer of 100 AU/mL or more was considered clinically relevant. The median time between the last infusion of the anti-CD20 treatment and the third vaccination was 22.9 weeks (range 15.1-31.3). After the third vaccination, one out of 16 patients showed an IgG titer deemed clinically relevant. Only the seroconverted patient had measurable B-cell counts at the time of the third vaccination.
The development of a humoral immune response remains rare in pwMS on anti-CD20 therapy, even after third dose of the homologous SARS-CoV-2 mRNA vaccine. It remains to be determined whether T-cell responses can compensate for the lack of seroconversion and provide sufficient protection against CoV-2 infections.
More details of treatment responsiveness
Pitzalis M, Idda ML, Lodde V, Loizedda A, Lobina M, Zoledziewska M, Virdis F, Delogu G, Pirinu F, Marini MG, Mingoia M, Frau J, Lorefice L, Fronza M, Carmagnini D, Carta E, Orrù V, Uzzau S, Solla P, Loi F, Devoto M, Steri M, Fiorillo E, Floris M, Zarbo IR, Cocco E, Cucca F. Effect of Different Disease-Modifying Therapies on Humoral Response to BNT162b2 Vaccine in Sardinian Multiple Sclerosis Patients. Front Immunol. 2021 Dec 9;12:781843. doi: 10.3389/fimmu.2021.781843.