MS Patients on Ocrelizumab May Have Lessened Immune Response to SARS-CoV-2

Patients with multiple sclerosis (MS) taking the monoclonal antibody ocrelizumab were shown to produce less of an immune response to infection with SARS-CoV-2, the virus that causes COVID-19, according to an abstract presented at this year’s American Academy of Neurology annual meeting.

“MS patients on B-cell depleting therapy, ocrelizumab, have attenuated antibody responses to SARS-CoV-2 virus and are much less likely than MS patients not on ocrelizumab to produce neutralizing antibodies against SARS-CoV-2,” lead study author Ilya Kister, MD, NYU Langone Health, said in a statement.

However, he added, T-cell responses against SARS-CoV-2 were similar between the groups and not reduced “regardless of the disease-modifying treatment.”

Both T-cell and antibody responses were measured among 100 patients with MS receiving care at the NYU Langone Multiple Sclerosis Center, who had not received a COVID-19 vaccine. The patient were taking either ocrelizumab, another disease-modifying treatment (DMT), or no DMT when infected with SARS-CoV-2. Their serostatus was determined via Elecsys Anti‐SARS‐CoV‐2, whereas antibody responses were evaluated via multiplex bead–based immunoassays against SARS-CoV-2 nucleocapsid and spike proteins.¹

Overall, SARS-CoV-2 antibodies were measured in most of the patients, all treatments considered, but levels of immunoglobulin G were seen to be much lower in the ocrelizumab-treated group compared with all other treatments.²

Among the 40 patients for whom antibody and T-cell results were available, 26 were on ocrelizumab, and of that group, 17 had had COVID-19 close to a year prior.¹ The Elecsys assay identified seropositive status in all but 2 of the patients with COVID-19, while the multiplex bead–based missed 1 seropositive patient. There were no false positives.

Patients (mean age, 41 years; 45% non-White; 70% female) were excluded from the study if they received high-dose steroids, intravenous immunoglobulin, plasma, or antibody treatment in the previous 3 months. Enrollment took place in January 2021, and immune responses were assessed through March 2021.²

“These findings suggest that ocrelizumab-treated patients are able to fight off COVID-19 infection despite depressed antibody responses,” Kister concluded, “presumably because other arms of the immune system—T-cells and innate immunity—provide adequate protection in the majority of cases.”

Reference

1. Kister I, Krogsgaard M, Mulligan MJ, et al. Preliminary results of ongoing, prospective study of antibody and T‐cell responses to SARS‐CoV‐2 in patients with MS on ocrelizumab or other disease‐modifying therapies. Presented at: Presented at: American Academy of Neurology 73rd Annual Meeting; April 17-22, 2021; Virtual. Accessed April 20, 2021. https://www.aan.com/siteassets/home-page/conferences-and-community/annual-meeting/abstracts-and-awards/abstracts/2021-emerging-science-abstracts.pdf

2. George J. COVID antibody responses reduced in some MS patients. Medpage Today. April 19, 2021. Accessed April 20, 2021. https://www.medpagetoday.com/meetingcoverage/aan/92165?