#MSCOVID19. Get Boosted if you have had CD20-depleting antibody

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I have had my booster. Have you had yours.? This study indicates that if you have had immune-depletion there may be merit in boosters

Otto C, Schwarz T, Jeworowski LM, Schmidt ML, Walper F, Pache F, Schindler P, Niederschweiberer M, Krumbholz A, Rose R, Drosten C, Ruprecht K, Corman VM. Humoral immune responses remain quantitatively impaired but improve qualitatively in anti-CD20 treated patients with multiple sclerosis after three or four COVID-19 vaccinations. MedRxiv 2022. doi:  https://doi.org/10.1101/2022.08.10.22278639

Immune responses in people with multiple sclerosis (pwMS) on disease-modifying therapies (DMTs) have been of significant interest throughout the COVID-19 pandemic. Lymphocyte-targeting immunotherapies including anti-CD20 treatments and sphingosine-1-phosphate receptor (S1PR) modulators attenuate antibody responses after vaccination. Evaluation of cellular responses after vaccination is therefore of particular importance in these populations. In this study, we analysed CD4 and CD8 T cell functional responses to SARS-CoV-2 spike peptides in healthy controls and pwMS on five different DMTs by flow cytometry. Although pwMS on anti-CD20 and S1PR therapies had low antibody responses after both 2 and 3 vaccine doses, T cell responses in pwMS on anti-CD20 therapies were preserved after a third vaccination, even when additional anti-CD20 treatment was administered between vaccine doses 2 and 3. PwMS taking S1PR modulators had low detectable T cell responses in peripheral blood. CD4 and CD8 T cell responses to SARS-CoV-2 variants of concern Delta and Omicron were lower than to the ancestral Wuhan-Hu-1 variant. Our results indicate the importance of assessing both cellular and humoral responses after vaccination and suggest that even in the absence of robust antibody responses vaccination can generate immune responses in pwMS.

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5 comments

  • Thanks, as ever, for all the info. Is there any evidence yet of there being a difference if people wait before a booster if on an anti cd20 where treatment is spaced? Eg with ocrelizumab every six months would it make any difference to the vaccination response from waiting one, two, four months?

  • Curious about the protocols suggest for someone who has just finished Mavenclad year 2 (whoop whoop)

    i have been told to wait around 2 months from starting the last week of the tablets.

    I am just wondering if there is a risk to wait too long and potentially get covid and being unvaccinated. |Versus getting the vaccine a month or 2 weeks earlier and having at least some protection?

    you are damned if you do, damned if you don’t

    • I guest the delay is based on available data . My take it that there is good evidence for vaccine efficacy. I am guessing most people have had some vaccine by now and so have some immunity. Optimizing protection.

  • Hi. I am on Ocrevus since July 2018. Had Covid – mild symptoms – on March 2020 (very first wave), then got 3 shots of Pfizer vaccine (3rd dose on December 2021), but got Covid again on April 2022. Since then, I have not got infected anymore although, due to my work and social life, I have been in touch with many people (I am a school teacher). Now I am debating on whether to get a 4th shot of vaccine or not. I honestly would not get it unless it is strongly advised. My next Ocrevus infusion is scheduled for mid-November. What do you think? And what do you think of doing the covid vaccine together with the anti-flu vaccine? Many thanks!

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