RT Journal Article
SR Electronic
T1 Low protection from breakthrough SARS-CoV-2 infection and mild disease course in ocrelizumab-treated patients with multiple sclerosis after three mRNA vaccine doses
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP jnnp-2022-330757
DO 10.1136/jnnp-2022-330757
A1 Frederik Novak
A1 Hamza Mahmood Bajwa
A1 John Eugenio Coia
A1 Anna Christine Nilsson
A1 Christian Nielsen
A1 Dorte K Holm
A1 Kamilla Østergaard
A1 Mathilde Vilhelmine Miller Hvidt
A1 Keld-Erik Byg
A1 Isik S Johansen
A1 Kristen Mittl
A1 William Rowles
A1 Scott S Zamvil
A1 Riley Bove
A1 Joseph J Sabatino, Jr
A1 Tobias Sejbaek
YR 2023
UL http://jnnp.bmj.com/content/early/2023/04/24/jnnp-2022-330757.abstract
AB Background Our study investigated the rate of breakthrough SARS-CoV-2 infection and clinical outcomes in a cohort of multiple sclerosis (MS) patients who were treated with the anti-CD20 monoclonal antibody (Ab), ocrelizumab, before first, second and third BNT162b2 mRNA vaccinations. To correlate clinical outcomes with the humoral and cellular response.Methods The study was a prospective non-randomised controlled multicentre trial observational study. Participants with a diagnosis of MS who were treated for at least 12 months with ocrelizumab prior to the first BNT162b2 mRNA vaccination were prospectively followed up from January 2021 to June 2022.Results Out of 54 participants, 32 (59.3%) developed a positive SARS-CoV-2 PCR test in the study period. Mild infection was observed in all infected participants. After the third vaccination, the non-infected participants had higher mean Ab levels compared to the infected participants (54.3 binding antibody unit (BAU)/mL vs 26.5 BAU/mL, p=0.030). The difference in reactivity between spike-specific CD4+ and CD8+ T lymphocytes in the two groups was not significant.Conclusion and relevance The study results demonstrate rates of 59% in breakthrough infections after the third SARS-CoV-2 mRNA vaccination in ocrelizumab-treated patients with MS, without resulting in critical disease courses. These findings suggest the need for continuous development of prophylactic treatments when proved important in the protection of severe breakthrough infection.