This paper from Milan, Italy, proves the point. Among the fingolimod group 10 patients (62.5%) had a positive serological response after vaccination and among ocrelizumab-treated patients, a positive serological test was found in six cases (37.5%). So the advice would be to go ahead and get the vaccine regardless of which DMT you are on.
Guerrieri et al. Serological response to SARS-CoV-2 vaccination in multiple sclerosis patients treated with fingolimod or ocrelizumab: an initial real-life experience. J Neurol. 2021 Jun 26;1-5.
Background: Recent observations suggest a lack of humoral response after SARS-CoV-2 vaccination in multiple sclerosis (MS) patients treated with fingolimod or ocrelizumab OBJECTIVES: To assess serological response to SARS-CoV-2 vaccination in MS patients receiving these disease-modifying treatments (DMTs) in a real-life setting.
Methods: Retrospective clinical data collection from MS patients followed at San Raffaele Hospital MS Centre (Milan, Italy). All patients treated with fingolimod or ocrelizumab who had received a complete anti-COVID-19 vaccination course, with no clinical history suggestive of previous SARS-CoV-2 infection and with an available post-vaccination serological assay obtained at least 14 days after vaccination completion were considered for the study.
Results: We collected data from 32 MS patients, 16 treated with fingolimod and 16 receiving ocrelizumab. Among the fingolimod group 10 patients (62.5%) had a positive serological response after vaccination and among ocrelizumab-treated patients a positive serological test was found in six cases (37.5%). No relation between serological response and clinical features (i.e., treatment duration, time between vaccination and last treatment dose, and white blood cells count) was identified.
Conclusions: Our initial real-life experience suggests a variable antibody production in MS patients receiving these DMTs. At present, there are no sufficient data to do not recommend anti-SARS-CoV-2 vaccine in these patients.
Excellent article and your thoughts on the matter. It is great to see that T & B responses are generated as well as the antibody response that everyone is so hung up on
Sorry must have missed this one. I have been trying to get an understandable idea of the potential sub-optimal level that my Pfizer vaccine might have due to Retuximab. I had my first jab an the 9th of January, my first gram of retuximab on the 19th of February, the second on the 5th March and my second Pfizer jab on the 3rd of April. The emerging stats (although) a bit unclear to me. Should I be seeking an antibody test or even trying to get a booster jab?
Yes, the anti-CD20 therapies blunt or reduce antibody responses to COVID-19 vaccines, which is related to how soon after the last dose of anti-CD20 therapy the vaccine was given. If the gap was more than 6 months since rituximab/ocrelizumab you are likely to have some antibodies. However, this is only half the story and it looks as if T-cell memory responses to the vaccine is generated, which should protect you from severe infection.
So if you are on an anti-CD20 therapy and have been vaccinated you are very likely to have some immunity to the virus and hence some protection. The latter may not stop you from getting infected with SARS-CoV-2 but is likely to stop you from getting a severe infection.
Saying this the majority of pwMS on an anti-CD20 therapy who get COVID-19 don't get severe COVID-19 and make a good recovery. This is telling us that B-cells are not essential in dealing with coronaviruses. What is more important, however, is age, disability and comorbidities (obesity, hypertension, diabetes, etc.).
My message to pwMS on anti-CD20 who have been double vaccinated is to reintegrate carefully back into society and to time your booster or 3rd dose of the vaccine to be as close as possible to your next infusion allowing a 2-3 week window before the infusion to allow an adequate immune response to develop.
If data emerges to delay dosing to ensure a vaccine response I will cover this in a separate post.
Hi Prof G - I really appreciate the huge amount of work you and your colleagues put into communicating various facets of MS via your online writings. This post is a clear example of that. Can I suggest one addition on this topic: a discussion of the potential for vaccines in general, and the covid vaccines in particularly, to themselves trigger or exacerbate autoimmune reactions, again both generally and more specifically with MS. Clearly there is a risk involved with all medical interventions, and also autoimmune risks with catching the wild covid virus itself. I also understand that it is likely too early to tell what the longer term risks may be. But I think a key driver behind your online writing is that educated and informed patients make better choices so it would be great if you could apply that lens to this question, given what is currently known.
Thank you! There is so much information here to digest. I hope I am an outlier of COVID vaccines and MS. I had COVID and was hospitalized for 13 days. I had convalescent plasma which I should have developed antibodies from the donor. I have had two Pfizer vaccines. Yet I still continue to test negative for antibodies (I've had this done twice). I have had both tests for COVID-19 vaccine immunity as well as SARS CoV2 IgG (COVID-19 antibodies)
I am going on nothing but faith that somewhere in my body there is a response mechanism to SARS-CoV-2 that will keep me healthy or at least not quite as sick as I was the first time around. I'm faced with upcoming decisions about whether to continue on ocreluzimab or look at other options. And I desperately want that decision to be grounded in science if possible.
We are collecting information from people with MS via the COVER MS study. You can learn more about this patient reported data collection at https://www.iconquerms.org/cover-ms-description.
There is so much we don't yet know about COVID, so for now I will continue to wear a mask, socially isolate and wash my hands until they are raw.
This paper from Milan, Italy, proves the point. Among the fingolimod group 10 patients (62.5%) had a positive serological response after vaccination and among ocrelizumab-treated patients, a positive serological test was found in six cases (37.5%). So the advice would be to go ahead and get the vaccine regardless of which DMT you are on.
Guerrieri et al. Serological response to SARS-CoV-2 vaccination in multiple sclerosis patients treated with fingolimod or ocrelizumab: an initial real-life experience. J Neurol. 2021 Jun 26;1-5.
Background: Recent observations suggest a lack of humoral response after SARS-CoV-2 vaccination in multiple sclerosis (MS) patients treated with fingolimod or ocrelizumab OBJECTIVES: To assess serological response to SARS-CoV-2 vaccination in MS patients receiving these disease-modifying treatments (DMTs) in a real-life setting.
Methods: Retrospective clinical data collection from MS patients followed at San Raffaele Hospital MS Centre (Milan, Italy). All patients treated with fingolimod or ocrelizumab who had received a complete anti-COVID-19 vaccination course, with no clinical history suggestive of previous SARS-CoV-2 infection and with an available post-vaccination serological assay obtained at least 14 days after vaccination completion were considered for the study.
Results: We collected data from 32 MS patients, 16 treated with fingolimod and 16 receiving ocrelizumab. Among the fingolimod group 10 patients (62.5%) had a positive serological response after vaccination and among ocrelizumab-treated patients a positive serological test was found in six cases (37.5%). No relation between serological response and clinical features (i.e., treatment duration, time between vaccination and last treatment dose, and white blood cells count) was identified.
Conclusions: Our initial real-life experience suggests a variable antibody production in MS patients receiving these DMTs. At present, there are no sufficient data to do not recommend anti-SARS-CoV-2 vaccine in these patients.
Excellent article and your thoughts on the matter. It is great to see that T & B responses are generated as well as the antibody response that everyone is so hung up on
Hi
Sorry must have missed this one. I have been trying to get an understandable idea of the potential sub-optimal level that my Pfizer vaccine might have due to Retuximab. I had my first jab an the 9th of January, my first gram of retuximab on the 19th of February, the second on the 5th March and my second Pfizer jab on the 3rd of April. The emerging stats (although) a bit unclear to me. Should I be seeking an antibody test or even trying to get a booster jab?
Thanks
RV
Yes, the anti-CD20 therapies blunt or reduce antibody responses to COVID-19 vaccines, which is related to how soon after the last dose of anti-CD20 therapy the vaccine was given. If the gap was more than 6 months since rituximab/ocrelizumab you are likely to have some antibodies. However, this is only half the story and it looks as if T-cell memory responses to the vaccine is generated, which should protect you from severe infection.
So if you are on an anti-CD20 therapy and have been vaccinated you are very likely to have some immunity to the virus and hence some protection. The latter may not stop you from getting infected with SARS-CoV-2 but is likely to stop you from getting a severe infection.
Saying this the majority of pwMS on an anti-CD20 therapy who get COVID-19 don't get severe COVID-19 and make a good recovery. This is telling us that B-cells are not essential in dealing with coronaviruses. What is more important, however, is age, disability and comorbidities (obesity, hypertension, diabetes, etc.).
My message to pwMS on anti-CD20 who have been double vaccinated is to reintegrate carefully back into society and to time your booster or 3rd dose of the vaccine to be as close as possible to your next infusion allowing a 2-3 week window before the infusion to allow an adequate immune response to develop.
If data emerges to delay dosing to ensure a vaccine response I will cover this in a separate post.
Many thanks for taking the time to answer my question. That’s been very helpful
Much appreciated
Regards
RV
Hi Prof G - I really appreciate the huge amount of work you and your colleagues put into communicating various facets of MS via your online writings. This post is a clear example of that. Can I suggest one addition on this topic: a discussion of the potential for vaccines in general, and the covid vaccines in particularly, to themselves trigger or exacerbate autoimmune reactions, again both generally and more specifically with MS. Clearly there is a risk involved with all medical interventions, and also autoimmune risks with catching the wild covid virus itself. I also understand that it is likely too early to tell what the longer term risks may be. But I think a key driver behind your online writing is that educated and informed patients make better choices so it would be great if you could apply that lens to this question, given what is currently known.
Hi Prof G,
I am on Fingolimod and have had both doses of the pfeizer vaccine. Is there a study I can join looking at immune response/antibody levels?
You can email me at amandahughes328@yahoo.com if there is!
Thanks, Amanda
Thank you for the straight answer and the detailed explanation.
Thank you! There is so much information here to digest. I hope I am an outlier of COVID vaccines and MS. I had COVID and was hospitalized for 13 days. I had convalescent plasma which I should have developed antibodies from the donor. I have had two Pfizer vaccines. Yet I still continue to test negative for antibodies (I've had this done twice). I have had both tests for COVID-19 vaccine immunity as well as SARS CoV2 IgG (COVID-19 antibodies)
I am going on nothing but faith that somewhere in my body there is a response mechanism to SARS-CoV-2 that will keep me healthy or at least not quite as sick as I was the first time around. I'm faced with upcoming decisions about whether to continue on ocreluzimab or look at other options. And I desperately want that decision to be grounded in science if possible.
We are collecting information from people with MS via the COVER MS study. You can learn more about this patient reported data collection at https://www.iconquerms.org/cover-ms-description.
There is so much we don't yet know about COVID, so for now I will continue to wear a mask, socially isolate and wash my hands until they are raw.
Great information! Well worth the read. Thank you
Excellent explainer about vaccines. Will share. Thank you!