Severe breakthrough COVID-19 after SARS-CoV-2 booster vaccination in an MS patient on ocrelizumab

ABSTRACT

Background: Many patients with multiple sclerosis are treated with immunomodulating therapies. Ocrelizumab decreases humoral responses after SARS-CoV-2 vaccination. Therefore, patients are offered additional booster vaccinations to increase these responses. However, it is unknown if an additional booster vaccination in patients on anti-CD20 therapy induces additional immunological response or better clinical protection. Case presentation 50-year old female with relapsing remitting multiple sclerosis treated with ocrelizumab since 2018. Case report The patient developed severe COVID-19 despite a booster SARS-CoV-2 vaccination requiring 11 days of hospitalization. She failed to mount a humoral response after the first, second and third Moderna vaccination and even after COVID-19. Conclusions: This case illustrates that some patients on anti-CD20 therapies are not capable of producing antibodies despite repeated vaccinations and/or SARS-CoV-2 infections. MS patients on ocrelizumab should stay vigilant regarding breakthrough COVID-19.