ECTRIMS 2021 (1): Vaccination against SARS-CoV2

This year, the ECTRIMS Congress was again held virtually due to the pandemic. While this was a pity, as large international congresses thrive on the personal exchange between doctors and scientists, there was still plenty of interesting things to see and hear this year.

During times of the pandemic, the pandemic was naturally one of the outstanding topics. The discussion focused primarily on the effect of COVID19 vaccinations on MS patients under specific immunotherapies. In the presentation of the Italian data on the vaccination of MS patients with already more than 1,300 data sets (CovaXiMS), patients who are treated with therapeutic antibodies that deplete B-lymphocytes – primarily the active substances Rituximab and Ocrelizumab – show a lower humoral immune response (=formation of antibodies) against SARS-CoV2.

T-cell response keeps virus in check

This is not such a surprising finding, as a weaker humoral immune reaction has been observed in the past in patients treated with Rituximab or Ocrelizumab when vaccinated against other pathogens. Nevertheless, this finding leads to uncertainty among doctors and patients – patients are afraid of being insufficiently protected against COVID19 despite vaccination, doctors were unsure whether they should vaccinate Ocrelizumab or Rituximab patients at all.

However, recent data show that patients treated with Rituxiamb or Ocrelizumab, despite the reduced humoral immune response, develop a sufficient, sometimes even excessive, T-cell response against the SARS-CoV2 virus. This means that sufficient specific T-lymphocytes (a special form of white blood cells) were formed by the vaccination, which are capable of directly killing the virus or virus-infected cells.

Antibody test unnecessary

These studies therefore also prove that an antibody test is not able to depict the entire immune response after a vaccination and therefore does not allow a reliable statement about the vaccination protection. Therefore, there is consensus among European MS experts that antibody testing after the COVID19 vaccination is not recommended, as no therapeutic conclusions can be drawn from the result. In addition, there is currently no immediate indication for a booster vaccination of MS patients at the European level.

Thus, MS patients who are treated with Rituximab or Ocrelizumab should feel safe after a double vaccination with the SARS-CoV2 in terms of a (severe) symptomatic course of a COVID19 infection. Anyone who still isn’t satisfied can get a booster shot in Germany – based on the STIKO recommendations.

The current status also makes it clear that vaccination of MS patients against SARS CoV2 is indicated, even if the treatment with Rituximab, Ocrelizumab or an S1P modulator (such as Fingolimod) is being carried out. It is a European consensus that there is no contraindication to vaccination in MS patients and that vaccination is always better than no vaccination (“Any immunity is better than no immunity”).

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