T-Cell and Humoral Response to SARS-CoV-2 Vaccine in Patients With MS on Ocrelizumab

Among patients with multiple sclerosis (MS) treated with ocrelizumab, vaccine-specific T-cell response was preserved, but humoral response was reduced compared with healthy individuals, according to study results published in JAMA Neurology.

Disease-modifying therapies for MS may have a significant impact on the immune response to SARS-CoV-2 vaccine and data on the efficacy of messenger RNA vaccines in this population are limited. The objective of the current study was to determine the T-cell and antibody response to the SARS-CoV-2 vaccine in patients with MS treated with ocrelizumab, compared with healthy participants.

The single center study included 49 patients with MS treated with ocrelizumab (67.3% women; mean age, 47.9 years) at Hadassah Medical Center in Jerusalem, Israel, as well as 23 untreated patients with MS (78.3% women; mean age, 49 years), and 40 healthy controls (62.5% women; mean age, 45.3 years). All participants received 2 doses of BNT162b2 vaccine (Pfizer/BioNTech) and donated blood 2 to 4 weeks after the second vaccine dose to assess vaccine antibody response according to S1/S2 immunoglobulin G (IgG) and spike receptor binding domain (RBD), and 2 to 8 weeks after the second dose to assess T-cell response.

Assessment of SARS-CoV-2 messenger RNA vaccine antibody response indicated that the mean anti-S1/S2 IgG levels (mean titer, 26.2 AU/mL) and mean anti-RBD IgG titer (mean titer, 376.5 AU/mL) were significantly lower in patients treated with ocrelizumab, compared with healthy participants (mean titers, 283 AU/mL and 12,712 AU/mL, respectively) and untreated patients with MS (mean titers, 288.3 AU/mL and 10,877 AU/mL, respectively).

None of the 8 weeks’ post-vaccination samples from 8 patients treated with ocrelizumab reached a positive serology threshold.

There was a positive association between SARS-CoV-2 IgG levels and time from last ocrelizumab treatment to vaccination. There was an increased probability of developing appropriate humoral responses among patients who were vaccinated ≥5 months following the last ocrelizumab dose compared to those who got the vaccine earlier (60.9% vs. 23.1%, respectively; P =.007).

Positive SARS-CoV-2 specific T-cell responses following vaccination were detected in 26 of 29 patients treated with ocrelizumab (89.7%), in all 15 vaccinated healthy controls (100%), with a similar mean number of responding T cells in both groups (mean, 15.36 vs. 14.33 spot-forming cells, respectively).

The study had several limitations, including the small sample size, short follow-up and lack of data on the persistence of antibody and T-cells response.

“Preserved vaccine-specific T-cell responses in patients with multiple sclerosis treated with ocrelizumab are reassuring and will help to develop therapeutic strategies in patients with multiple sclerosis during the COVID-19 pandemic,” wrote the researchers.

Disclosure: This research was supported by F. Hoffmann-La Roche Ltd. Please see the original reference for a full list of disclosures.

Reference

Brill L, Rechtman A, Zveik O, et al. Humoral and T-Cell response to SARS-CoV-2 vaccination in patients with multiple sclerosis treated with ocrelizumab. JAMA Neurol. Published online September 23, 2021. doi: 10.1001/jamaneurol.2021.3599