Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis

Novak, Frederik; Nilsson, Anna Christine; Nielsen, Christian; Holm, Dorte K.; Østergaard, Kamilla; Bystrup, Anna; Byg, Keld-Erik; Johansen, Isik S.; Mittl, Kristen; Rowles, William; Mcpolin, Kira; Spencer, Collin; Sagan, Sharon; Gerungan, Chloe; Wilson, Michael R.; Zamvil, Scott S.; Bove, Riley; Sabatino, Joseph J.; Sejbaek, Tobias

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 2(nd) 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.