Longitudinal humoral response after SARS-CoV-2 vaccination in ocrelizumab treated MS patients: To wait and repopulate?

Z L E van Kempen; L Wieske; E W Stalman; L Y L Kummer; P J van Dam; A G Volkers; L Boekel; A A Toorop; E M M Strijbis; S W Tas; G J Wolbink; M Löwenberg; C van Sandt; A Ten Brinke; N J M Verstegen; M Steenhuis; T W Kuijpers; S M van Ham; T Rispens; F Eftimov; J Killestein; T2B! immunity against SARS-CoV-2 study group

doi:10.1016/j.msard.2021.103416

Longitudinal humoral response after SARS-CoV-2 vaccination in ocrelizumab treated MS patients: To wait and repopulate?

Mult Scler Relat Disord. 2022 Jan:57:103416. doi: 10.1016/j.msard.2021.103416. Epub 2021 Nov 23.

Authors

Z L E van Kempen¹, L Wieske², E W Stalman², L Y L Kummer³, P J van Dam², A G Volkers⁴, L Boekel⁵, A A Toorop⁶, E M M Strijbis⁶, S W Tas⁷, G J Wolbink⁵, M Löwenberg⁴, C van Sandt⁸, A Ten Brinke⁹, N J M Verstegen⁹, M Steenhuis⁹, T W Kuijpers¹⁰, S M van Ham¹¹, T Rispens⁹, F Eftimov², J Killestein⁶; T2B! immunity against SARS-CoV-2 study group

Affiliations

¹ Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland. Electronic address: [email protected].
² Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland.
³ Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland.
⁴ Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland.
⁵ Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, the Netherland.
⁶ Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland.
⁷ Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland.
⁸ Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland; Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth, Melbourne, VIC 3000, USA.
⁹ Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland.
¹⁰ Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland.
¹¹ Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland; Swammerdam Institute for Life Sciences, University of Amsterdam, the Netherland.

Abstract

Objective: The objective of this study was to measure humoral responses after SARS-CoV-2 vaccination in MS patients treated with ocrelizumab (OCR) compared to MS patients without disease modifying therapies (DMTs) in relation to timing of vaccination and B-cell count.

Methods: OCR treated patients were divided into an early and a late group (cut-off time 12 weeks between infusion and first vaccination). Patients were vaccinated with mRNA-1273 (Moderna). B-cells were measured at baseline (time of first vaccination) and SARS-CoV-2 antibodies were measured at baseline, day 28, 42, 52 and 70.

Results: 87 patients were included (62 OCR patients, 29 patients without DMTs). At day 70, seroconversion occurred in 39.3% of OCR patients compared to 100% of MS patients without DMTs. In OCR patients, seroconversion varied between 26% (early group) to 50% (late group) and between 27% (low B-cells) to 56% (at least 1 detectable B-cell/µL).

Conclusions: Low B-cell counts prior to vaccination and shorter time between OCR infusion and vaccination may negatively influence humoral response but does not preclude seroconversion. We advise OCR treated patients to get their first vaccination as soon as possible. In case of an additional booster vaccination, timing of vaccination based on B-cell count and time after last infusion may be considered.

Keywords: Antibodies; COVID-19; Multiple sclerosis; Ocrelizumab; SARS-CoV-2.

MeSH terms

Antibodies, Monoclonal, Humanized
COVID-19 Vaccines
COVID-19*
Humans
Multiple Sclerosis*
SARS-CoV-2
Vaccination

Substances

Antibodies, Monoclonal, Humanized
COVID-19 Vaccines
ocrelizumab