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The following is an exchange I have had regarding this Newsletter on LinkedIn. Interesting that people from other disease areas are finding this useful.

Dear Prof G

Many thanks for your summary and thoughts especially regarding anti-CD20 therapies and immune response towards the COVID-19 vaccine.

My husband is on Rituximab therapy for non-Hodgkin's lymphoma (NHL) and has been advised to skip the next dose in September, get a booster vaccination (as he is not producing sufficient levels of antibodies) around December and restart vaccination in late winter around February.

The T cell response has never been evaluated.

My question now would be: does this approach make sense to you? Or should he just keep on with Rituximab and trust on the T cells doing their work?

Kind regards

Mrs ****

Answer:

It all depends on his NHL. You don't want to compromise its treatment. If the oncologist is happy to delay treatment then it makes sense to do that for the booster. How long you delay is the next question. I suspect you will need to delay the booster for long enough to see some peripheral blood B cell reconstitution. But as for now he has done the right thing and had the vaccine; during the pandemic, it is better to have the vaccine and get some immunity than to be left vulnerable to the virus. As I have said many times before, partial immunity is better than no immunity.

I hope this helps

Prof G

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Jul 16, 2021Liked by Gavin Giovannoni

Thanks, Prof!

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Jul 17, 2021Liked by Gavin Giovannoni

Thank you, Prof G! This was golden.

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Jul 16, 2021Liked by Gavin Giovannoni

Thanks Prof G! I’ve been hoping for a post from you about exactly this. My Neuro in the United States told me to watch for your posts about this topic as I am keenly interested (PwMS taking ocrelizimab).

So helpful for me to read and learn and share.

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I understand that Ocrevus ramps up my T cells and ramps down my B cells. I was told that the T cells would be very effective against COVID 19. I have had 2 Phizer shots. I am overweight. Is a third shot a good option. Thanks for your summary. It is 5:30 am. Not sure I processed.

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author

Ocrelizumab blunts B-cell or antibody responses to the COVID-19 vaccines. However, you may have sufficient T-cell responses to protect you from infection and severe disease. Yes, I would recommend booster doses to all patients with MS on an anti-CD20 therapy. if you want to increase your chances of having a vaccine response you may need to miss a dose or two and with for some peripheral blood B-cell reconstitution to occur. I suggest discussing this with your HCP.

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Dear Prof G

My husband just had his first half dose of ocrevus and is due his next half in two weeks. How long after his infusion do you suggest he gets his first Pfizer Vaccine? We are in Sydney and in a hot spot and the Delta strain is all around us. We basically stay home as we are in lockdown.. I’ve had my first Pfizer shot to keep my husband safer, but we are just not sure if and how long after his Infusions he should have his shot.

Thanks in advance

Maggie

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author

He is unlikely to make an antibody response to the vaccine, but may still make a T-cell response. The data we have in relation to other vaccines suggest waiting for 3 months after the last dose of ocrelizumab before being vaccinated.

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Do you have any advisement on timing after infusion for the third jab for those on Ocrevus? It is now on offer where I live for those who are immune compromised & making a decision on when to get jabbed is now a reality.

Thank you again for this post - I just reread it!

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What about Alemtuzumab Prof. G? my husband finished his two courses 2 years ago and his lymph count is around 1.2 now.

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author

His immune system has reconstituted so vaccine responses should be fine. Saying that about 5% of the general population don't make adequate vaccine responses.

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Thanks for this professor. I have question. I had never been on any anti-CD20 therapy when I got the vaccine. (Had been on Copaxone for years, then took a year off DMT). Four weeks after my second vaccine, I started Ocrevus for the first time. So should I assume that Ocrevus did not impact my body's vaccine response much?

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Yes, your immune system should have had enough time to make an antibody response. Please note that vaccines are not 100% effective, even in the normal population a small number of people don't respond to the vaccine.

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thanks for answering. The Delta variant is so transmissible I plan on masking indoors.

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Does Kesimpta share the same exact safety profile?

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author

Yes and no. As ofatumumab is given as a subcutaneous injection the injection site reactions are less than the infusion reactions seen with ocrelizumab. It is a lower dose and hence reconstitution is quicker, which mean it may cause less hypogammaglobulinaemia. However, it is too early to make a call on this we need long-term data.

In relation to B-cell depletion and effects on vaccines; I assume they will be the same.

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It may be slightly better as it does not deplete B cells as well as Ocrevus does.

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