COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases

Abstract

Based on the known and emerging biology of autoimmune diseases and COVID‐19, it was hypothesised that whilst B‐cell depletion should not necessarily expose people to severe SARS‐CoV‐2‐related issues, it may inhibit or blunt the protective immunity following infection and vaccination. This is supported clinically, as the majority of SARS‐CoV‐2 infected, CD20‐depleted people with autoimmunity, have recovered. However, in CD‐20 treated people until naïve B‐cells repopulate, based on B‐cell repopulation‐kinetics and vaccination responses, from published rituximab, and unpublished ocrelizumab (NCT00676715, NCT02545868) trial data shown here suggests that it may be possible to undertake dose‐interruption to maintain inflammatory disease control, whilst allowing effective vaccination against SARS‐CoV‐29, if and when an effective vaccine is available.

COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review

“…The safety and efficacy of approvedvaccines for SARS-CoV-2 in MS patients on treatment with DMTs should be carefully considered. ( Ciotti et al, 2020 , Baker et al, 2020 )…”

“…First, live, and attenuated viruses are contraindicated in immunosuppressed patients, and under these circumstances, DNA-RNA vaccines will be useful in patients on immunosuppressive agents. ( Baker et al, 2020 )…”

“…For instance, in Rheumatoid Arthritis, it has been shown that following treatment with Rituximab, there is a more markedly blunted seroconversion and titer after vaccination during periods of peripheral B cell depletion and a more significant, but still blunted, vaccine response 6–10 months after infusion. ( Baker et al, 2020 )…”

“…Accordingly, it is possible to create a time-window to vaccinate an individual on the base of differential kinetics of repopulation with pathogenic memory B cells and naive B cells. ( Baker et al, 2020 )…”

The presence of SARS-CoV2 antibodies in MS patients

“…One immediate question has been – should treatment be altered – either by delaying treatment, or by changing the specific disease modifying treatment (DMT) as a direct result of the pandemic? Thus far, there has been reassuring evidence published regarding patients on all DMT classes, including ‘induction’ therapies, alemtuzumab ( Carandini et al, 2020 ) and cladribine ( Dersch et al, 2020 ), as well as continuous infusion, oral and injectable treatments (natalizumab ( Borriello and Ianniello, 2020 , Parrotta et al, 2020 ), anti-CD20 treatments ( Parrotta et al, 2020 , Thornton and Harel, 2020 , Baker et al, 2020 ), dimethyl fumarate ( Parrotta et al, 2020 ), fingolimod ( Bollo et al, 2020 )/siponimod ( Parrotta et al, 2020 ), teriflunomide ( Bollo et al, 2020 ), interferons ( Parrotta et al, 2020 ) and glatiramer ( Parrotta et al, 2020 )) surviving infection. This mirrors our own center's experience as well.…”