Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis

Frederik Novak, Anna Christine Nilsson, Christian Nielsen, Dorte K Holm, Kamilla Østergaard, Anna Bystrup, Keld-Erik Byg, Isik S Johansen, Kristen Mittl, William Rowles, Kira Mcpolin, Collin Spencer, Sharon Sagan, Chloe Gerungan, Michael R Wilson, Scott S Zamvil, Riley Bove, Joseph J Sabatino, Tobias Sejbaek


BACKGROUND: The immunogenicity of COVID-19 vaccine among patients receiving anti-CD20 monoclonal antibody (Ab) treatment has not been fully investigated. Detectable levels of SARS-CoV-2 immunoglobulin G (IgG) are believed to have a predictive value for immune protection against COVID-19 and is currently a surrogate indicator for vaccine efficacy.

OBJECTIVE: To determine IgG Abs in anti-CD20 treated patients with multiple sclerosis (MS).

METHOD: IgG Abs against SARS-CoV-2 spike receptor-binding domain were measured with the SARS-CoV-2 IgG II Quant assay (Abbott Laboratories) before and after vaccination (n = 60).

RESULTS: 36.7% of patients mounted a positive SARS-CoV-2 spike Ab response after the second dose of vaccine. Five patients (8.3%) developed Abs >264 BAU/mL, another 12 patients (20%) developed intermediate Abs between 54 BAU/mL and 264 BAU/mL and five patients (8.3%) had low levels <54 BAU/mL. Of all seropositive patients, 63.6% converted from seronegative to seropositive after the 2nd vaccine.

CONCLUSION: Our study demonstrates decreased humoral response after BNT162b2 mRNA SARS-CoV-2 vaccine in MS patients receiving B-cell depleting therapy. Clinicians should advise patients treated with anti-CD20 to avoid exposure to SARS-CoV-2. Future studies should investigate the implications of a third booster vaccine in patients with low or absent Abs after vaccination.

Original languageEnglish
Article number103251
JournalMultiple Sclerosis and Related Disorders
Pages (from-to)103251
Publication statusPublished - 2021


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