With such a shortage of Ronapreve in the UK and globally every dose that is currently been given prophylactically is one less potentially life-saving dose for someone on an anti-CD20 with COVID
Thank you, I enjoyed listening to your podcast, great format. Hadn't realised importance of IgA in preventing infection getting hold in first place, long before CD8 or even IgG called in to play.
Valid point re access to treatments.
Amazing to think less than 2 years into pandemic, the world has a choice of vaccines, antibodies and small molecule antivirals to choose from. Now we just have to share them between us...
I am wondering about whether to get the Moderna booster, given that I had my last Ocrevus infusion in late July and that my CD19 count is currently 0.
I had my second Ocrevus infusion in early October 2020, followed by two doses of the Pfizer vaccine in March. I failed to seroconvert. In consultation with my neurologist, I postponed my third Ocrevus infusion, scheduled for early April, and got a third Pfizer dose in early June (my CD19 count had risen to 2.1%). After the third dose, I was able to seroconvert and had high antibody levels according to blood tests in late June, early August and early November.
I got my third Ocrevus infusion in late July. A few days ago, a new blood test showed that my antibody level had fallen a lot (to a relatively low level) compared to early November (!), and that my CD19 count was 0% (as one would expect given that my last infusion was in late July).
Given this context, would you recommend getting the Moderna booster?
My reasoning is that the booster could potentially help, and that there is not much downside to getting it. Is this reasoning sound? My idea is that I could again delay my next Ocrevus infusion, scheduled for late January, by one or two months so as to achieve some B cell repletion, then get another booster in February or March, and hopefully seroconvert then.
Loved everything about this - so much so I sent it to my oncologist friend/colleague who educated me on “prophylaxis” & covid + my MS scenario (Ocrevus) just last night - On what it is, what it means and what is available now and on the horizon.
I am wondering if Roche, who is the parent company for this treatment and for Ocrevus , is planning to advise for those on ocrelizimab …. ?
Adding the audio was incredibly helpful and your podcast tone/style really works beautifully….
Thank you for the education & for posting/creating with panache …!
I agree we should use the mabs for treatment of acute cases - for vaccinated patients.
After that, vaccine non-responders (or the rare few who truly cannot take the vacine) should get them as prophylaxis. I have very little patience for the unvaccinated by choice these days.
I'm sure you have it right with current real-world constraints. But I am curious: Assuming a situation where supply wasn't an issue, do you think doctors and regulators will agree that anti-body PrEP for immunocompromised/sero-non-converting is warranted/justified/worth the $$? I have this dream that in a year or so I will be able to get an infusion that makes me (fingolimod, no Abs after 3x Moderna shots) similarly safe to vaccinated healthy people.
I was with this post (and all ProfG does, as a paid subscriber) until the last paragraph and name-calling/shaming of a patient. Where is the compassion? The empathy for obvious anxiety? Don’t we want to support patients who are pro-active in their health decisions, not belittle their possible WRONGTHINK?
This patient is sincerely concerned about his lack of protection despite his best efforts. Offer him some preventative measures in case he must go out in public:
Salt water with 15ml hydrogen peroxide and 4 drops of iodine (salt solution: 15-20ml of salt to 8-12oz water). Gargle and spit prior to contact with public or 3x/day in early Covid.
A nasal drop solution of 1% iodine (mix 5ml iodine into 50ml dropper bottle. Fill with distilled, sterile or previously boiled water) To use tilt head back, apply 4-5 drops to each nostril. Keep tilted for a few minutes, drain.
Zinc Citrate 50mg (6= 100mg elemental zinc)
Vitamin D3 5,000IU (or more if deficient)
Vitamin C 3,000-8,000mg daily in divided doses
Quercetin 500mg twice daily (take with Vit C for best absorption)
Melatonin 5-10mg at bedtime
Curcumin 500-1000mg twice daily
EGCG 400mg in the AM
Using Aspirin 81-325mg daily (if able) to prevent early clots should they occur with the vaccine or early infection
All these are over the counter in the US. I am unsure of what you have there. But if you have, at minimum, access to iodine you can make the first two. That will kill and prevent the virus in your nose/mouth. Those steps with hand washing and distancing as much as possible will help tremendously.
At the very least a provider should offer some basic tactics to ease a patient’s troubled mind.
I truly regret feeling compelled to post the above. I was completely shocked by the shaming of a shut-in, concerned patient- needlessly. This felt like a personal attack of someone who may have just needed updated information. Up until the last paragraph I felt educated by multitude of new information here.
This seems out of character for you ProfG- and for that I am grateful. We become accustomed to your caring attitude and informative style.
Thank you, I enjoyed listening to your podcast, great format. Hadn't realised importance of IgA in preventing infection getting hold in first place, long before CD8 or even IgG called in to play.
Valid point re access to treatments.
Amazing to think less than 2 years into pandemic, the world has a choice of vaccines, antibodies and small molecule antivirals to choose from. Now we just have to share them between us...
Thank you, this post is really helpful.
I am wondering about whether to get the Moderna booster, given that I had my last Ocrevus infusion in late July and that my CD19 count is currently 0.
I had my second Ocrevus infusion in early October 2020, followed by two doses of the Pfizer vaccine in March. I failed to seroconvert. In consultation with my neurologist, I postponed my third Ocrevus infusion, scheduled for early April, and got a third Pfizer dose in early June (my CD19 count had risen to 2.1%). After the third dose, I was able to seroconvert and had high antibody levels according to blood tests in late June, early August and early November.
I got my third Ocrevus infusion in late July. A few days ago, a new blood test showed that my antibody level had fallen a lot (to a relatively low level) compared to early November (!), and that my CD19 count was 0% (as one would expect given that my last infusion was in late July).
Given this context, would you recommend getting the Moderna booster?
My reasoning is that the booster could potentially help, and that there is not much downside to getting it. Is this reasoning sound? My idea is that I could again delay my next Ocrevus infusion, scheduled for late January, by one or two months so as to achieve some B cell repletion, then get another booster in February or March, and hopefully seroconvert then.
Loved everything about this - so much so I sent it to my oncologist friend/colleague who educated me on “prophylaxis” & covid + my MS scenario (Ocrevus) just last night - On what it is, what it means and what is available now and on the horizon.
I am wondering if Roche, who is the parent company for this treatment and for Ocrevus , is planning to advise for those on ocrelizimab …. ?
Adding the audio was incredibly helpful and your podcast tone/style really works beautifully….
Thank you for the education & for posting/creating with panache …!
I am biased.
I agree we should use the mabs for treatment of acute cases - for vaccinated patients.
After that, vaccine non-responders (or the rare few who truly cannot take the vacine) should get them as prophylaxis. I have very little patience for the unvaccinated by choice these days.
I'm sure you have it right with current real-world constraints. But I am curious: Assuming a situation where supply wasn't an issue, do you think doctors and regulators will agree that anti-body PrEP for immunocompromised/sero-non-converting is warranted/justified/worth the $$? I have this dream that in a year or so I will be able to get an infusion that makes me (fingolimod, no Abs after 3x Moderna shots) similarly safe to vaccinated healthy people.
Way to kick a man when he is down!
I was with this post (and all ProfG does, as a paid subscriber) until the last paragraph and name-calling/shaming of a patient. Where is the compassion? The empathy for obvious anxiety? Don’t we want to support patients who are pro-active in their health decisions, not belittle their possible WRONGTHINK?
This patient is sincerely concerned about his lack of protection despite his best efforts. Offer him some preventative measures in case he must go out in public:
Salt water with 15ml hydrogen peroxide and 4 drops of iodine (salt solution: 15-20ml of salt to 8-12oz water). Gargle and spit prior to contact with public or 3x/day in early Covid.
A nasal drop solution of 1% iodine (mix 5ml iodine into 50ml dropper bottle. Fill with distilled, sterile or previously boiled water) To use tilt head back, apply 4-5 drops to each nostril. Keep tilted for a few minutes, drain.
Zinc Citrate 50mg (6= 100mg elemental zinc)
Vitamin D3 5,000IU (or more if deficient)
Vitamin C 3,000-8,000mg daily in divided doses
Quercetin 500mg twice daily (take with Vit C for best absorption)
Melatonin 5-10mg at bedtime
Curcumin 500-1000mg twice daily
EGCG 400mg in the AM
Using Aspirin 81-325mg daily (if able) to prevent early clots should they occur with the vaccine or early infection
All these are over the counter in the US. I am unsure of what you have there. But if you have, at minimum, access to iodine you can make the first two. That will kill and prevent the virus in your nose/mouth. Those steps with hand washing and distancing as much as possible will help tremendously.
At the very least a provider should offer some basic tactics to ease a patient’s troubled mind.
I truly regret feeling compelled to post the above. I was completely shocked by the shaming of a shut-in, concerned patient- needlessly. This felt like a personal attack of someone who may have just needed updated information. Up until the last paragraph I felt educated by multitude of new information here.
This seems out of character for you ProfG- and for that I am grateful. We become accustomed to your caring attitude and informative style.