Survey of Immune Response to SARS-CoV-2 mRNA Vaccinesin Patients on anti-CD20 Therapy for Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder

ABSTRACT

Objective: To determine the optimal time for SARS-CoV-2 mRNA vaccination, after infusion with anti-CD20 therapy, in patients with multiple sclerosis and neuromyelitis optica spectrum disorder (MS/NMOSD) as there are currently no guidelines. Background: To achieve adequate immunity against SARS-CoV-2, mRNA vaccines (BNT162b2 or mRNA-1273) stimulate B and T cells. Therefore, it is imperative to ensure MS/NMOSD patients on anti-CD20 therapy have enough B cells to produce antibodies at the time of vaccination. Design/Methods: This was a retrospective study at Rutgers New Jersey Medical School, Newark. We identified all MS/NMOSD patients on anti-CD20 therapy (Ocrelizumab or Rituximab) who received a SARS-CoV-2 mRNA vaccine. Some of these patients were not on the standard, biannual dosing schedule due to treatment guideline modifications made during the pandemic. Antibody response to the SARS-CoV-2 spike protein was checked at least 4 weeks after the second dose of the vaccine. Results: We analyzed 23 vaccinated MS/NMOSD patients on anti-CD20 therapy (87% on Ocrelizumab and 13% on Rituximab). Patients were divided into two groups those who developed antibodies after vaccination (52%) and those who did not (48%). There was no significant difference between the two groups in age, gender, MS type, expanded disability status scale, type of anti-CD20 therapy, and brand of vaccine. However, there was statistical significance in the interval between infusion and vaccination between the groups (p-value -0.03;9.2±3.9 vs 6.2±3.1months). Additionally, none of these patients had a relapse. Conclusions: The mean interval between infusion and vaccination was 9.2 months in those that developed antibodies and 6.2 months in those that did not. Patients on anti-CD20 therapy may mount an immune response when vaccinated if the time between infusion and vaccination is extended beyond 6 months. The main limitation of this study was the variable timing in the collection of CD19 counts.