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ACTRIMS 2022 | COVID booster vaccines do not lead to humoral responses in patients with MS treated with DMTs

Celia Oreja-Guevara, MD, PhD, University Hospital San Carlos, Madrid, Spain, shares updated findings from an investigation into humoral immune responses to SARS-CoV-2 vaccination in patients with multiple sclerosis (MS) receiving disease modifying therapy (DMT). Previously reported data from more than 150 vaccinated patients with MS showed that humoral immune responses were comparable to healthy controls in most cases, excluding those treated with rituximab or ocrelizumab who did not develop a humoral response. In this updated analysis, it was shown that the use of a third booster vaccine did not lead to successful post-vaccination humoral responses in patients treated with anti-CD20 therapy. The timing of vaccination in relation to the last treatment dose was identified as a critical factor for determining responsiveness; a longer washout period led to successful responses in several patients. Additionally, patients receiving ofatumumab were found to mount better responses compared to patients on other anti-CD20 therapies. This interview took place at the ACTRIMS Forum 2022 in West Palm Beach, Florida.

Transcript (edited for clarity)

We have performed a study with the patients that are vaccinated with multiple sclerosis, with the COVID-19 vaccination. And the update we have present in the ACTRIMS is that most of the treatments, so the interferons, teriflunomide, dimethyl fumarate, cladribine… so they have no action in the vaccination. It means when the patients are vaccinated and they have these treatments, they have a normal number of antibodies, but we have described that the patients treated with an anti-CD20, they cannot have a complete response, an antibody response, a humoral response...

We have performed a study with the patients that are vaccinated with multiple sclerosis, with the COVID-19 vaccination. And the update we have present in the ACTRIMS is that most of the treatments, so the interferons, teriflunomide, dimethyl fumarate, cladribine… so they have no action in the vaccination. It means when the patients are vaccinated and they have these treatments, they have a normal number of antibodies, but we have described that the patients treated with an anti-CD20, they cannot have a complete response, an antibody response, a humoral response. So what we have seen now, is that these patients, the patients treated with anti-CD20, now they have received most of them a third dose with the hope that they can have now a humoral response. But what we have seen is that they have no humoral response.

So it’s the same what you do, you can put a third vaccination a fourth, fifth… It’s the same, you will not have a humoral response because the problem is the time. So it’s very important to have a very long washout period between the anti-CD20 and the vaccination. And when you have a long washout period, like for example we have two patients that they were one year without treatment, these patients they can have a humoral response.

But the patients that have the treatment every six months, they don’t have a humoral response. So that is really very important, the time, the washout period. And is the same if you put two, three, four, five time the vaccination, that will not have a response when you have a very short washout period. And the second part that we have seen that is different, we have a look at the ofatumumab. Ofatumumab is an anti-CD2O, but ofatumumab is not doing a depletion of B-cells and patients with ofatumumab, they have a better response than the other anti-CD2O and some of them they have a humoral response.

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