In multiple sclerosis (MS) patients treated with ocrelizumab, the vaccine-specific T-cell response was maintained, but the humoral response was reduced compared to healthy subjects, according to study results published in JAMA Neurology.
Disease-modifying therapies for MS can have a significant impact on the immune response to the SARS-CoV-2 vaccine, and data on the effectiveness of messenger RNA vaccines in this population are limited. The aim of the current study was to determine the T cell and antibody response to the SARS-CoV-2 vaccine in MS patients treated with ocrelizumab compared to healthy participants.
The single-center study enrolled 49 ocrelizumab-treated MS patients (67.3% women; mean age 47.9 years) at Hadassah Medical Center in Jerusalem, Israel, and 23 untreated MS patients (78.3% women; mean age 49 years.). ) and 40 healthy control persons (62.5% women; mean age 45.3 years). All participants received 2 doses of BNT162b2 vaccine (Pfizer / BioNTech) and donated blood 2-4 weeks after the second dose of vaccine to target the vaccine antibody response according to S1 / S2 immunoglobulin G (IgG) and spike receptor binding domain (RBD) assess, and 2 to 8 weeks after the second dose, to assess the T cell response.
The evaluation of the SARS-CoV-2 messenger RNA vaccine antibody response showed that the mean anti-S1 / S2 IgG levels (mean titer 26.2 AU / ml) and the mean anti-RBD IgG titer (mean titer 376.5 AU / ml) were significantly lower in ocrelizumab-treated patients compared to healthy participants (mean titer, 283 AU / ml and 12,712 AU / ml, respectively) and untreated patients with MS (mean titer, 288.3 AU / ml or 10,877 AU / ml).
None of the 8 ocrelizumab-treated samples examined 8 weeks after vaccination achieved a positive serological threshold.
There was a positive association between SARS-CoV-2 IgG levels and the time from last ocrelizumab treatment to vaccination. Patients vaccinated ≥ 5 months after the last dose of ocrelizumab were more likely to develop an adequate humoral response compared to those who received the vaccine earlier (60.9% and 23.1%, respectively) ; P = 0.007).
Positive SARS-CoV-2-specific T-cell responses after vaccination were found in 26 of 29 ocrelizumab-treated patients (89.7%) in all 15 vaccinated healthy controls (100%), with a similar mean number of respondents T cells in both groups (mean 15.36 vs. 14.33 staining cells).
The study had several limitations, including the small sample size, the short follow-up time, and the lack of data on the persistence of the antibody and T-cell response.
“The vaccine-specific T-cell responses obtained in patients with multiple sclerosis treated with ocrelizumab are reassuring and will help develop therapeutic strategies in patients with multiple sclerosis during the COVID-19 pandemic,” the researchers write.
Disclosure: This study was conducted by F. Hoffmann-La Roche Ltd. supports. For a full list of disclosures, see the original reference.
Brill L, Rechtman A, Zveik O, et al. Humoral and T-cell response to SARS-CoV-2 vaccination in multiple sclerosis patients treated with ocrelizumab. JAMA Neurol. Published online 23 September 2021. doi: 10.1001 / jamaneurol.2021.3599