Journal of Multiple Sclerosis
ISSN - 2376-0389NLM - 101654564
Prospective - (2021) Volume 8, Issue 4
As the number of people access vaccines to coronavirus disease (COVID-19) are increasing, those with Multiple Sclerosis (MS), Neuromyelitis Optica (NMO), and other are concerned about about the safety and efficacy of these vaccines as these individuals are receiving immunosuppressive medications. B cell depletion with anti-CD20 drugs such as rituximab, ocrelizumab, or the more recently approved, ofatumamab [1], are of particular interest because prior studies have suggested that there is a decrease in vaccine-induced protection in the setting of CD20 blockade [2]. While there is yet no published data about vaccine effectiveness of COVID-19 in any immunosuppressed populations, there are convincing arguments on both sides of the debate surrounding whether CD20 blocking immunotherapy may have an impact on the efficacy of new RNA-based COVID-19 vaccines.
Several previous studies of vaccine responses in patients receiving anti-CD20 therapies have been done with rituximab and ocrelizumab. In a prospective controlled study of vaccination in rituximab-treated pa-tients with rheumatoid arthritis, predominantly B cell-dependent vaccination responses (to pneumococcal vaccine and the neoantigen keyhole limpet hemocyanin (KLH)) were decreased, while more T-cell dependent responses, as measured by the response to Tetanus Toxoid (TT) vaccine and the delayedtype hypersensitivity response, were preserved in both groups.
The recently completed ‘Study to Evaluate the Effects of Ocrelizumab on Immune Responses in Partici-pants With Relapsing Forms of Multiple Sclerosis’ (VELOCE) was a trial conducted to specifically assess humoral responses to various (non-COVID-19) inactivated vaccines in ocrelizumabtreated patients with multiple sclerosis [3].
This study signifies attenuated humoral responses, as measured by antibody titers, to tetanus-toxoid containing vaccine, Pneumovax vaccine, KLH, and influenza vaccine in patients who had received ocrelizumab. The outcome measures in the trial were antibody titers, and anti-CD20 medications are known to mechanistically block formation of new memory B cells and lower antibody production. Vac-cine efficacy, however, is not exclusively antibody-mediated, and no study has looked directly at infection rates after vaccination, as this would not be feasible in the setting of extremely low baseline rates of most vaccine-preventable disease. So, the ultimate question of whether patients on CD20-depleting medications receive less real-world protection from vaccines remains unaddressed.
Citation: Aron. The Use of RNA-Based COVID-19 Vaccines and B Cell Therapy. J Mult Scler (Foster City), 2021, 9(4), 243.
Received: 02-Apr-2021 Published: 27-Apr-2021, DOI: 10.35248/2376-0389.21.8.243
Copyright: @2021 Aron. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
