Persistently reduced humoral and sustained cellular immune response from first to third SARS-CoV-2 mRNA vaccination in anti-CD20-treated multiple sclerosis patients

Evaluation of humoral and cellular response to third dose of BNT162b2 mRNA COVID-19 vaccine in patients treated with B-cell depleting therapy

“…Our findings largely agree with those recently published about seroconversion after the third dose in anti-CD20 treated patients affected by MS, RA, or other diseases against which these drugs are increasingly used; seroconversion has been reported to vary between 21 and 70% after 2 doses and 33–57% after 3 doses [ 16 , 24 , [26] , [27] , [28] ]. The rate of responders among the anti-CD20 group in our cohort after the second dose was 50% and after the third it became 55%, thus still markedly reduced.…”

“…Our study aimed to compare the humoral and cellular response after the third dose of vaccine against COVID-19 in patients exposed to anti-CD20 with healthy controls, and patients with immune-mediated diseases not exposed to anti-CD20, as these groups show various degrees of impaired response after 2 or 3 doses and different kinetics of waning immunity [ [23] , [24] , [25] ].…”

Monoclonal antibodies for mild-to-moderate COVID-19 in multiple sclerosis: A case series

“…Our case series is limited by the small sample size, though comprehensive of MS patients at risk of worse COVID-19 outcomes due to a variety of reasons. In particular, looking at vaccine response, in line with previous studies [ 10 ], our case series confirmed the lack of serological response to vaccination in ocrelizumab-treated patients also after booster dose, while we did not assess T-cell responses [ [11] , [12] , [13] , [14] ]. In the current scenario of endemic COVID-19 and continuous treatment with immunosuppressive DMTs affecting both humoral and cellular immunity [ 15 ], passive immunization with monoclonal antibodies will likely be a cornerstone in preventing severe COVID-19 in this category of patients.…”

Response of COVID-19 vaccination in multiple sclerosis patients following disease-modifying therapies: A meta-analysis

“…Of note, previous limited investigations on the third dose of SARS-CoV-2 vaccine demonstrated that the humoral or cellular response was not significantly increased compared to that following the second dose in pwMS with anti-CD20 treatment. 37 , 38 , 39 However, one study reported that T-cell response decreased 6 months after the second vaccination, but restored after the administration of a third vaccine. 39 Moreover, there was no significant difference in cellular response between pwMS on anti-CD20 and healthy controls after receiving two or three doses of vaccines, 39 supporting our finding that anti-CD20 may not affect the T-cell response to vaccination against SARS-CoV-2.…”