COVID-19 Vaccine Efficacy in Anti-CD20 Treated Patients With MS, Neuromyelitis Optica

Researchers sought to assess whether COVID-19 infection developed despite of vaccination among patients with multiple sclerosis or neuromyelitis optica spectrum disorder, using a French database of these patient populations.

Among patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), treatment with anti-CD20 immunosuppressive therapies (e.g., ocrelizumab or rituximab) or the immunomodulating medication fingolimod, may be associated with a lower anti-spike protein-based immunoglobulin-G response following COVID-19 vaccination, according to a study published in the Multiple Sclerosis Journal.

Immunosuppressive therapies, like anti-CD20 and fingolimod, are proven to help reduce the rate of relapse and disability worsening among patients with MS and NMOSD. However, over time, these therapies have been linked to an increased risk for severe infections. Previous research has found exposure to anti-CD20 therapies is associated with COVID-19 severity with lower anti-spike humoral immunity following vaccination, according to the researchers.

The objective of the current study was to assess whether COVID-19 infection developed despite of vaccination in patients with MS or NMOSD, utilizing the COVISEP registry—a French database of patients with MS or NMOSD who develop COVID-19.

In the case series evaluation, researchers extracted all cases of COVID-19 infection that had occurred since December 21, 2020, which translated to 460 cases. A total of 16 patients with MS were infected with COVID-19 at >7 days after they had received their initial dose of the BNT162b2 vaccine and prior to having received their second dose. There were 18 cases of COVID-19 reported following 2 doses of the vaccine, with 13 of the patients having been treated with an anti-CD20 agent and 4 treated with fingolimod. All of the COVID-19 cases were mild in severity.

In the current preliminary study, although 72% of the patients who developed SARS-CoV-2 infection following double-dose vaccination had received anti-CD20 treatment, they represented only 20% of nonvaccinated individuals with COVID-19. Based on these data, it is possible that ocrelizumab and rituximab may not only impair the COVID-19 humoral response, but it may worsen vaccine efficacy as well.

The study’s findings strengthen the recommendation for a third COVID-19 vaccination among immunocompromised individuals. Because of concerns about low immunogenicity of COVID-19 vaccines among anti-CD20–treated patients, on April 6, 2021, the health authorities in France recommended that a third dose of the BNT162b2 vaccine be administered 4 weeks after the second dose in the immunocompromised group of patients, the researchers noted.

They concluded, “These preliminary findings stress the need for a prospective clinical and biological follow-up on COVID-19 vaccine efficacy among this population exposed to immunosuppressive therapies, and further studies are needed to assess the impact of prior vaccination on COVID-19 severity among immunocompromised patients.”

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Januel E, De Seze J, Vermersch P, et al; COVISEP Investigators. Post-vaccine COVID-19 in patients with multiple sclerosis or neuromyelitis optica.  Mult Scler. Published online December 21, 2021. doi:10.1177/13524585211049737