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Novak F, Nilsson AC, Nielsen C, Holm DK, Østergaard K, Bystrup A, Byg KE, Johansen IS, Mittl K, Rowles W, Mcpolin K, Spencer C, Sagan S, Gerungan C, Wilson MR, Zamvil SS, Bove R, Sabatino JJ, Sejbaek T. Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103251. [PMID: 34571415 PMCID: PMC8426319 DOI: 10.1016/j.msard.2021.103251] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 01/07/2023]
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.
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Affiliation(s)
- Frederik Novak
- Department of Neurology, Hospital Southwest Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anna Christine Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Anna Bystrup
- Department of Neurology, Hospitalsenhed Midt, Viborg, Denmark
| | - Keld-Erik Byg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Isik S Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Kristen Mittl
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - William Rowles
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Kira Mcpolin
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Collin Spencer
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Sharon Sagan
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Chloe Gerungan
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Riley Bove
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Joseph J Sabatino
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Tobias Sejbaek
- Department of Neurology, Hospital Southwest Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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