Anti-severe acute respiratory syndrome coronavirus-2 antibody responses following Pfizer-BioNTech vaccination in a patient with multiple sclerosis treated with ocrelizumab: a case report

Abstract

Patients with multiple sclerosis (MS) repeatedly receive therapies that cause B-lymphocyte depletion. This may lead to abnormal immune responses following coronavirus disease 2019 (COVID-19) vaccination, as has been suggested previously. We therefore evaluated post-vaccination immune responses in a patient with MS treated with ocrelizumab. The intervals between ocrelizumab infusions and vaccination were as recommended by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society. A reactive immune response was observed in this patient following vaccination. This suggests that appropriate intervals between ocrelizumab infusions and COVID-19 vaccinations may permit the generation of efficacious immune responses in patients receiving B-lymphocyte depleting therapies.

Immune responses to SARS‐CoV‐2 vaccination in multiple sclerosis: a systematic review/meta‐analysis

“…1 ). 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 …”

“…While the timing of infusion in relationship with vaccination was not available for most patients, sensitivity analysis showed in our model with vaccine type that infusion timing did not affect antibody response. Also, despite B cell depletion, some pwMS still had detectable antibodies in ocrelizumab 24 and in other DMTs, such as alemtuzumab. 25 …”

“…While the timing of infusion in relationship with vaccination was not available for most patients, sensitivity analysis showed in our model with vaccine type that infusion timing did not affect antibody response. Also, despite B cell depletion, some pwMS still had detectable antibodies in ocrelizumab 24 and in other DMTs, such as alemtuzumab. 25 However, while B-cell-depleting therapies may reduce anti-SARS-CoV-2 antibodies and memory B cell responses, in contrast, the majority of patients had evidence of vaccine-generated antigen-specific CD4 + and CD8 + T-cell responses following vaccination with mRNA vaccines, due to T cell priming.…”

Central nervous system manifestations following vaccination against COVID-19

“…In addition, there was no increase in the risk of acute MS relapse after the third dose of Pfizer-BioNTech vaccination, compared to the second dose ( Dreyer-Alster et al, 2022 ). A previous study highlighted that the optimal approach to enhance antibody responses in patients with MS is to have at least a four-to-six-month gap between monoclonal antibody therapy and the first dose of the Pfizer-BioNTech vaccine ( Mado et al, 2021 ). A gap of four to six weeks for the second dose should be considered as well ( Mado et al, 2021 ).…”

“…A previous study highlighted that the optimal approach to enhance antibody responses in patients with MS is to have at least a four-to-six-month gap between monoclonal antibody therapy and the first dose of the Pfizer-BioNTech vaccine ( Mado et al, 2021 ). A gap of four to six weeks for the second dose should be considered as well ( Mado et al, 2021 ).…”