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

doi:10.1016/j.msard.2021.103251

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

Department of Neurology

36 Citations (Scopus)

Abstract

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 language	English
Article number	103251
Journal	Multiple Sclerosis and Related Disorders
Volume	56
Pages (from-to)	103251
ISSN	2211-0348
DOIs	https://doi.org/10.1016/j.msard.2021.103251
Publication status	Published - 2021

Keywords

Anti-cd20
Clinical trials
Covid-19
Ocrelizumab
Sars-cov-2
Vaccination

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Novak, F., Nilsson, A. C., Nielsen, C., Holm, D. K., Østergaard, K., Bystrup, A., Byg, K.-E., Johansen, I. S., Mittl, K., Rowles, W., Mcpolin, K., Spencer, C., Sagan, S., Gerungan, C., Wilson, M. R., Zamvil, S. S., Bove, R., Sabatino, J. J., & Sejbaek, T. (2021). Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis. Multiple Sclerosis and Related Disorders, 56, 103251. Article 103251. https://doi.org/10.1016/j.msard.2021.103251

Novak, F, Nilsson, AC, Nielsen, C, Holm, DK, Østergaard, K, Bystrup, A, Byg, K-E, Johansen, IS, Mittl, K, Rowles, W, Mcpolin, K, Spencer, C, Sagan, S, Gerungan, C, Wilson, MR, Zamvil, SS, Bove, R, Sabatino, JJ & Sejbaek, T 2021, 'Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis', Multiple Sclerosis and Related Disorders, vol. 56, 103251, pp. 103251. https://doi.org/10.1016/j.msard.2021.103251

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

abstract = "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.",

keywords = "Anti-cd20, Clinical trials, Covid-19, Ocrelizumab, Sars-cov-2, Vaccination",

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

year = "2021",

doi = "10.1016/j.msard.2021.103251",

language = "English",

volume = "56",

pages = "103251",

journal = "Multiple Sclerosis and Related Disorders",

issn = "2211-0348",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis

AU - Novak, Frederik

AU - Nilsson, Anna Christine

AU - Nielsen, Christian

AU - Holm, Dorte K

AU - Østergaard, Kamilla

AU - Bystrup, Anna

AU - Byg, Keld-Erik

AU - Johansen, Isik S

AU - Mittl, Kristen

AU - Rowles, William

AU - Mcpolin, Kira

AU - Spencer, Collin

AU - Sagan, Sharon

AU - Gerungan, Chloe

AU - Wilson, Michael R

AU - Zamvil, Scott S

AU - Bove, Riley

AU - Sabatino, Joseph J

AU - Sejbaek, Tobias

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - Anti-cd20

KW - Clinical trials

KW - Covid-19

KW - Ocrelizumab

KW - Sars-cov-2

KW - Vaccination

UR - https://www.scopus.com/pages/publications/85115661953

U2 - 10.1016/j.msard.2021.103251

DO - 10.1016/j.msard.2021.103251

M3 - Journal article

C2 - 34571415

SN - 2211-0348

VL - 56

SP - 103251

JO - Multiple Sclerosis and Related Disorders

JF - Multiple Sclerosis and Related Disorders

M1 - 103251

ER -

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

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Keywords

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