Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis

Frederik Novak, Anna Christine Nilsson, Christian Nielsen, Dorte K. Holm, Kamilla Østergaard, Anna Bystrup, Keld Erik Byg, Isik S. Johansen, Kristen Mittl, William Rowles, Kira Mcpolin, Collin Spencer, Sharon Sagan, Chloe Gerungan, Michael R. Wilson, Scott S. Zamvil, Riley Bove, Joseph J. Sabatino, Tobias Sejbaek*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Background: The immunogenicity of COVID-19 vaccine among patients receiving anti-CD20 monoclonal antibody (Ab) treatment has not been fully investigated. Detectable levels of SARS-CoV-2 immunoglobulin G (IgG) are believed to have a predictive value for immune protection against COVID-19 and is currently a surrogate indicator for vaccine efficacy. Objective: To determine IgG Abs in anti-CD20 treated patients with multiple sclerosis (MS). Method: IgG Abs against SARS-CoV-2 spike receptor–binding domain were measured with the SARS-CoV-2 IgG II Quant assay (Abbott Laboratories) before and after vaccination (n = 60). Results: 36.7% of patients mounted a positive SARS-CoV-2 spike Ab response after the second dose of vaccine. Five patients (8.3%) developed Abs >264 BAU/mL, another 12 patients (20%) developed intermediate Abs between 54 BAU/mL and 264 BAU/mL and five patients (8.3%) had low levels <54 BAU/mL. Of all seropositive patients, 63.6% converted from seronegative to seropositive after the 2nd vaccine. Conclusion: Our study demonstrates decreased humoral response after BNT162b2 mRNA SARS-CoV-2 vaccine in MS patients receiving B-cell depleting therapy. Clinicians should advise patients treated with anti-CD20 to avoid exposure to SARS-CoV-2. Future studies should investigate the implications of a third booster vaccine in patients with low or absent Abs after vaccination.

Original languageEnglish
Article number103251
JournalMultiple Sclerosis and Related Disorders
Number of pages5
Publication statusPublished - Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s)


  • Anti-cd20
  • Clinical trials
  • Covid-19
  • Ocrelizumab
  • Sars-cov-2
  • Vaccination


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