This case study is about whether or not you need to delay your next ocrelizumab infusion before having your booster COVID-19 vaccine and which vaccine to choose if you can.
A couple of questions Prof.....at the start of the vaccination period your advice was that some immunity was better than none. For a number of ocrelizumab patients, by the time they wait for b-cell repopulation we will be in to next Spring and the winter wave will have hopefully passed. Should these patients grab the chance to boost t-cell responses or not bother? Also, the flu jab invites are beginning to come out. Again, i assume the advice would be to take up this offer but will it really help with no bcells?
Re: "grab the chance to boost t-cell responses or not bother"
I don't really know as we don't have any evidence to support going ahead now or delaying vaccination for later. I assume you may be able to do both, i.e. have the vaccine now and miss of delay your next course of ocrelizumab and have a fourth booster dose later.
The flu vaccine is not quite the same as the COVID-19 vaccine. In the VELOCE study patients on ocrelizumab did boost the anti-FLU antibody titres so I would suggest going ahead and have the flu vaccine and don't worry about things.
This is really helpful. I'm in a similar position in terms of vaccination dates and ocrevus schedules, though a little older at 40. I haven't had an antibody test though, so should probably seek one out.
Thanks. This query came to me as a direct message on Twitter. Anonymising it and answering it on this platform so others can learn from it is the main objective of the MS-Selfie case studies.
Thanks, I missed that. When repeating the calculation with other neurological conditions ticked the risk of dying drops to 1 in 250,000. I suspect the latter does not include DMTs and immunosuppression, which is why the RA/SLE category may be more relevant to this case as most RA/SLE patients will be on some form of immunosuppression.
I think the point I am trying to make is that for this patient the risk of dying from COVID-19 is very low so she should not get anxious about not seroconverting after vaccination. What I haven't discussed is the issue of long-COVID, which occurs in about 10% of people who have COVID-19. Some pwMS may want to consider this when making a decision.
Hi Prof, would this apply to someone like me who has been on rituximab for 4 1/2 years last infusion 18 months ago delayed due to multiple shingles infections. I have now had all my necessary booster vaccinations including Shingrix. Am I correct in thinking that we would also recommend that if possible I should have Moderna as first choice booster 3 if not possible then Pfizer.
Thanks for sharing this case study Prof G, it's reassuring to read as the lady and myself are a similar-ish age/weight/Ocrevus/antibody response.. roll on the next vaccine..
I’m 61…. I have delayed, possibly stopped, my infusion of orcrelizumab. Am talking to neurologist on 6/10. I feel the risk of Covid greater than the risk of a relapse… and tbh…maybe I shouldn’t be on it anyway? I can’t stay locked away, I have young grandchildren and I want to enjoy them. Time for a re-think.
A couple of questions Prof.....at the start of the vaccination period your advice was that some immunity was better than none. For a number of ocrelizumab patients, by the time they wait for b-cell repopulation we will be in to next Spring and the winter wave will have hopefully passed. Should these patients grab the chance to boost t-cell responses or not bother? Also, the flu jab invites are beginning to come out. Again, i assume the advice would be to take up this offer but will it really help with no bcells?
Re: "grab the chance to boost t-cell responses or not bother"
I don't really know as we don't have any evidence to support going ahead now or delaying vaccination for later. I assume you may be able to do both, i.e. have the vaccine now and miss of delay your next course of ocrelizumab and have a fourth booster dose later.
The flu vaccine is not quite the same as the COVID-19 vaccine. In the VELOCE study patients on ocrelizumab did boost the anti-FLU antibody titres so I would suggest going ahead and have the flu vaccine and don't worry about things.
This is really helpful. I'm in a similar position in terms of vaccination dates and ocrevus schedules, though a little older at 40. I haven't had an antibody test though, so should probably seek one out.
Thanks. This query came to me as a direct message on Twitter. Anonymising it and answering it on this platform so others can learn from it is the main objective of the MS-Selfie case studies.
Definitely works!
There is a box for neurological disease including MS. No mention of dmt.
Thanks, I missed that. When repeating the calculation with other neurological conditions ticked the risk of dying drops to 1 in 250,000. I suspect the latter does not include DMTs and immunosuppression, which is why the RA/SLE category may be more relevant to this case as most RA/SLE patients will be on some form of immunosuppression.
I think the point I am trying to make is that for this patient the risk of dying from COVID-19 is very low so she should not get anxious about not seroconverting after vaccination. What I haven't discussed is the issue of long-COVID, which occurs in about 10% of people who have COVID-19. Some pwMS may want to consider this when making a decision.
Good point. Interesting generally that MS is not on the immunosuppresion radar so far as government and media are concerned.
Cancer, transplant: yes obviously to both.
Rheumatoid arthritis: yes often gets a mention.
MS: never. Are we too quiet?
Hi Prof, would this apply to someone like me who has been on rituximab for 4 1/2 years last infusion 18 months ago delayed due to multiple shingles infections. I have now had all my necessary booster vaccinations including Shingrix. Am I correct in thinking that we would also recommend that if possible I should have Moderna as first choice booster 3 if not possible then Pfizer.
Thanks for sharing this case study Prof G, it's reassuring to read as the lady and myself are a similar-ish age/weight/Ocrevus/antibody response.. roll on the next vaccine..
I’m 61…. I have delayed, possibly stopped, my infusion of orcrelizumab. Am talking to neurologist on 6/10. I feel the risk of Covid greater than the risk of a relapse… and tbh…maybe I shouldn’t be on it anyway? I can’t stay locked away, I have young grandchildren and I want to enjoy them. Time for a re-think.