#MSCOVID19: vaccines and DMTs

So if you are someone with MS who is shielding or being very careful about social distancing and want to avoid getting COVID-19 you may be considering what your own exit strategy is. How do you de-risk yourself and prevent yourself from becoming infected with SARS-CoV-2? 

At present, it looks as if the UK government’s strategy is to ring-fence you with people who are immune to SARS-CoV-2, the so-called herd immunity paradigm, and hope an effective vaccine emerges in the next 12-18 months to secure the safety of the high-risk or vulnerable population. This strategy is high-risk because there is no guarantee that sufficient numbers of healthy people in the general population will get COVID-19 to ring-fence the vulnerable. To be honest there are too many vulnerable people. In addition, there will always be holes in the science behind the herd-immunity paradigm; who says immunity to SARS-CoV-2 will be long-term and why wouldn’t new strains of virus emerge to fool the immune system. This means that vulnerable people will have to live in fear that they may acquire COVID-19 unless they get an asymptomatic/mild infection and/or vaccinated and have proof they have neutralising anti-viral protective immunity against SARS-CoV-2. 

So the next questions are if and when an effective SARS-CoV-2 vaccine emerges (1) how good will the vaccine be and (2) if I am on a disease-modifying therapy will I respond to the vaccine? 

In general, vaccines can be hit and miss. Politicians, particularly Donald Trump, and the general public seem to think that an effective vaccine is imminent. Yes, it may be but it is more likely, based on industry timelines, that an effective vaccine for SARS-CoV-2 is years away. Developing a vaccine for respiratory viruses is not easy, particularly for viruses that mutate rapidly and have mechanisms built into their nucleic acid which results in antigenic drift, i.e. the proteins they express on their surface rapidly mutate to escape immune detection. The latter is a particular problem with for example the influenza virus; antigenic drift happens annually. We also know this is a problem with coronaviruses because immunity is not life long and wanes within years. This is why we get recurrent common colds.  

The other problem with viruses and vaccines is the so-called original antigenic sin. This is when you make an immune response to a virus or vaccine antigen. The virus then mutates and when you get infected with the new strain the antibodies you make to the original strain or vaccine don’t neutralise the new strain and may even enhance infection with the new strain. In addition, your immune system doesn’t treat the new strain as a new infection and thinks it is the original strain and hence doesn’t make new antibodies against the new strain. This why it is referred to as antigenic sin. Vaccine development has a long history of failing because of these sorts of issues and is why we haven’t got highly effective vaccines against major viruses such as dengue fever. 

Another issue with SARS-CoV-2 is that it looks like some of the important binding sites on the spike protein of the virus are heavily modified with sugar molecules. This means that neutralizing antibodies against SARS-CoV-2 may need to be against so-called glycoprotein segments of the spike protein. Glycoprotein vaccines are much more difficult to make and in themselves are less effective in inducing antibodies than pure protein vaccines. The reason for this is that the immune system processes sugar (glyco) antigens differently to protein antigens. 

I am telling you all this to make you aware that vaccine development is difficult, very difficult, and there are a lot of issues that will need to be considered to make sure a vaccine against SARS-CoV-2 is effective and safe. 

The other issue is having an immune system that is capable of mounting an immune response to a vaccine. I  think in general a live-attenuated SARS-CoV-2 vaccine is unlikely to be developed. Live vaccines tend to be legacy vaccines from an era before we had the tools to make recombinant proteins. Therefore it is highly likely that all the vaccines that will be developed will either be nucleic acid, protein or glycoprotein component vaccines. In general immune responses to vaccines are blunted by immunosuppressive therapies. This has relevance to pwMS because the DMT you are on may block the required immune response to the vaccine. So your careful and patient waiting for an effective vaccine may be futile.  

In general, interferon-beta, glatiramer acetate, teriflunomide, dimethyl fumarate and natalizumab are unlikely to block or attenuate immune responses to a component SARS-CoV-2 vaccine. Similarly, once immune system reconstitution has occurred post alemtuzumab, cladribine, mitoxantrone or HSCT vaccine responses should be restored to normal or near normal. In the depletion phase of IRTs (immune reconstitution therapies) it is likely that vaccine responses will be blunted. In the case of S1P modulators, such as fingolimod and siponimod, and the anti-CD20 therapies (ocrelizumab and rituximab), which are continuous immunosuppressive therapies, vaccine responses are likely to be blunted. I use the term blunted rather than inhibited responses because pwMS on these therapies may still make antibodies to the vaccine components but not to the required level to create protective immunity. 

The story with anti-CD20 therapies is potentially more complex. Surprisingly, antibody response to common vaccines occur on anti-CD20 therapies, but antibody response to glycoprotein vaccines, for example, the pneumococcal vaccine are blunted or inhibited the most. This may be particularly relevant to a SARS-CoV-2 vaccine that is likely to require antibodies to glycoprotein antigens to generate neutralizing antibodies, i.e. antibodies that neutralise the virus and prevent infection. 

Is this information important for pwMS? Yes, I think it is and may affect whether or not pwMS start or continue treatment with S1P modulators or anti-CD20 therapies.  In other words, if you want to make yourself ‘vaccine ready’ you need to consider your DMT choice.

As a research group, we are very interested in the antibody responses to SARS-CoV-2 in pwMS who have had COVID-19. We are in the process of trying to rapidly develop an antibody assay for IgG and IgM antibodies that can differentiate between binding and neutralizing anti-SARS-CoV-2 antibodies. This will allow us to study whether or not the immune response to SARS-CoV-2 is different in patients on S1P-modulators and anti-CD20 therapies and to compare these responses to patients on other DMTs and to patients who are not on DMTs. This will potentially allow us to give patients detailed information in the future about their risk of getting delayed COVID-19 and whether or not they respond to emerging vaccines once they arrive.

In conclusion, as we start to think about exit strategies for pwMS post-COVID-19 being able to respond to a future SARS-CoV-2 vaccine is a major factor HCPs and pwMS need to consider when deciding on what DMT to start or continue with for the long-term. 

Now some questions for you. For those of you who consider yourself, ‘COVID-19 vulnerable’ is being able to respond to a future SARS-CoV-2 vaccine relevant to you? Does it affect your thinking about which DMT you want to be treated with? Please let’s start a discussion on this important topic. 

I think the vaccine issues is important enough for me to have added a new column to my DMT COVID-19 table (version 4.0) and to change the colouring scheme to a patchwork. 

CoI: multiple

40 thoughts on “#MSCOVID19: vaccines and DMTs”

  1. I’d like a vaccine before I start year 2 of clad
    This will be between nov 2020 and may 2021
    On basis I can delay second year clad by 6 months
    If vaccine not ready until nov 2021 can I delay year 2 of clad by 12 months
    Or would that be not recommended
    How about 9 months?

  2. “The government has created a coronavirus taskforce to support the rapid development and manufacture of a vaccine.
    Business Secretary Alok Sharma said a vaccine was a “colossal undertaking” and there “are no guarantees”.”

    Looks like the government is being realistic about a vaccine.

    Could you join the taskforce? In various scenarios (not just health), there are people who try to do things and people who stand on the sidelines (media, other experts) saying “I wouldn’t have done it like that…”. It would be good to get those people involved from the outset rather than act as real time auditors, or as vultures when a project doesn’t work as planned.

    1. More meaningless guff from Sharma et al, his Downing Street updates are the worst and that’s a subterranean level bar. it’s as credible as Hancock’s assurances on PPE and testing.

  3. Ok, let me start by saying blaming our President is easy for people to do. He doesn’t mind. He is facing the beginning of our second Great Depression. Hungry people, empty store shelves, collapsed markets. He is surrounded by Medical Experts and, Yes, Scientists who guide his actions. He has a responsibility to explore all possibilities and to give us Hope too. That’s Empathetic, not political.
    Third in succession to President is Nancy Pelosi, who adjourned the House of Representatives went back to her mansion and went on late night comedy showing her refrigerator stocked with $13/pint ice cream and basket full of chocolate. She is revered.
    Let me clarify for you, it is Bill Gates pushing a vaccine. https://www.vox.com/science-and-health/2019/12/13/21004456/bill-gates-mckinsey-global-public-health-bcg And an “immunity card” and a nanotechnology chip to identify us. I won’t take it.
    WHO is also complicit In not being open about The ? Man made Deadly virus. They are involved with Bill Gates. They experimented their vaccines on unsuspecting Africans and Monkeys. They also gave pregnant Rhesus monkeys gadolinium BTW.
    Chinese Communists also have not been honest. Please don’t leave them out.
    Me? I have a mask, naturally socially distant. If I get it and die, well I’ve had a good life.
    I will Not take a Gates vaccine. He couldn’t make an HIV or Malaria vaccine. He has spent billions on that failure.
    Food for thought. Our people are being quarantined to death.

      1. It IS one of my bigger worries here in Trumpland. So maybe we can just laugh for the time being:

        There isn’t any iceberg.
        There was an iceberg but it’s in a totally different ocean.
        The iceberg is in this ocean but it will melt very soon.
        There is an iceberg but we didn’t hit the iceberg.
        We hit the iceberg, but the damage will be repaired very shortly.
        The iceberg is a Chinese iceberg.
        We are taking on water but every passenger who wants a lifeboat can get a lifeboat, and they are beautiful lifeboats.
        Look, passengers need to ask nicely for the lifeboats if they want them.
        We don’t have any lifeboats, we’re not lifeboat distributors.
        Passengers should have planned for icebergs and brought their own lifeboats.
        I really don’t think we need that many lifeboats.
        We have lifeboats and they’re supposed to be our lifeboats, not the passengers’ lifeboats.
        The lifeboats were left on shore by the last captain of this ship.
        Nobody could have foreseen the iceberg.

      2. I have some of those specimens in my own family. …

        Don’t bother MD2. Mary is after a darwin award.

    1. Sadest part is your the person that Trumps stupidity will hurt the most. Whose medicare he removed and played with lives of over 300 million talking down the threat of the pandemic. Then put his crocked family froends in charge to cash in on various tasks forces. Prime example Vincent McManon on his get America open. All needs to don’t get support his go on his racist/ misogynistic rants and talk about wall to feed your racist and deluded views of superiority based on the wavelength of electromagnetic radiation you reflect back. America is in its last throes as superpower.

  4. This is such a tough one for me. I’m 58, fairly fit and I’ve been on Fingolimod for 4 years. I haven’t relapsed at all since starting Fingo and mri’s show no progression. Apart from a nasty bout of facial shingles it’s been so far, so good but I feel uncomfortable being continually immune suppressed, especially as I get older.
    I’m currently practising social distancing but I don’t go out much other than to take excersise, walk the dog etc. I have wondered about my own personal exit plan and after reading this, I think I shall wait for more information to come in. IE: statistics re people on Fingo who have had the virus, also the results of the trial of fingolimod in serious cases of COVID-19, which will hopefully be in by July. In the meantime I’ll carry on taking it and practice shielding myself.
    Thank you for continually updating us with the current information.

  5. I’m following your blog with interest. I’m 51 and on ocrelizumab although my 2nd full fur in May has been postponed. I’m interested about the vaccine and if the timing with my infusions might be relevant like it is with the annual flu vaccination.

    1. Post alemtuzumab 7 years and advised as part of aftercare never to have a live vaccine again. Surely this would mean everyone who has been treated with alemtuzumab would unable to receive such a vaccine?

    2. The likely answer is yes, the more B cells you have the better the chance that you will respond. It will also depend on the vaccine strategy, if it is one or more injecions

  6. Thanks for your update today on this. The updates here are invaluable and so appreciated in the current climate of the unknown. Having been dx with RRMS in Jan 2019 I was keen to take control of things following three relapses by Nov 2019 and was lucky to start Ocrelizumab in the UK in Feb 2020, having my two half doses which both luckily went smoothly for me. Truly thankful for this. I had an MRI mid-March 2020 which showed my MS to be stable. Hopefully this will continue to be the case. I’m keen to have a Sars-Cov-2 vaccine when one might be available in the future and for this reason would consider de-escalation to Teriflunomide as a 2nd line dmt when I was at a safe point past August this year to start. I’m aware ocrelizumab can stay active within the system for longer than 6 months. Would this be a possible option for myself and others in the same position to de-escalate at this point? Or would we need to free ourselves fully of dmt (almost like a washout period) and then start the 2nd line dmt, potentially aubagio if possible, once we have had the vaccine? Or is there no need for a wash out period in this, case? I’m mindful it’s important to stay on some form of dmt therapy to maintain control of MS long term and avoid the body relapsing in an ideal world. I am currently social distancing, but not shielding. I am exercising outside my home but am not visiting busy public places, shops just to be stringent. I am keen to be in a position to be able to return to work where possible and in which case would be pro for a vaccine long term. What are your thoughts on ‘return to work’ in June if lockdown is raised for those on anti-cd20 therapies?

    1. Also self isolating, but desperate to get back to work asap for my mental wellbeing…. Feels like this is getting further & further away….

      1. Post alemtuzumab 7 years. Advised never to have a live vaccine as part of aftercare. Does this mean that everyone who has been treated with alemtuzumab would be unable to receive such a vaccine?

    2. I basically want to know exactly the same as this person!
      38yrs, fit healthy, EDSS 0/1. RRMS on ocrelizumab. Also a HCP. Not shielding, our exercising etc but working from home. Extremely keen to know if I can go back to work when lockdown starts to lift.
      Also think I may even have had covid but it was March 5th so not sure if that was too early.
      I was told when starting ocrevus I should have flu vaccine but response may be blunted. I had it as usual. I was thinking I would have covid vaccine (if there ever was one) and accept it may be blunted. But are you saying it would be worth switching to a less efficient DMT instead? Eek. Lots to think about

  7. Yes, it is going to influence my decision. I’ve been on Natalizumab, which has worked wonders, but due to being JCV+ve, I switched to EID a year ago and I was considering to switch DMT. I was thinking of either fingolimod or ocrelizumab since they seem to block the rebound. However, both will probably blunt the vaccine response. That leaves me with very limited choices and the prospect of staying on Natalizumab which may be risky.

  8. I’m coming out of the vulnerable phase of Alemtuzumab and am absolutely interested in the efficacy of a vaccine. On the plus side, it sounds like those of us on a non-reversibl therapy (HCST and Alemtuzumab) will be able to respond to vaccines after reconstitution and those on anti-CD20 therapies could pause treatment while a vaccine is administered. Is this last point correct?

    1. In principle yes, in reality CD20 depleters seem to work for 12-18 months after the last dose. I for one would not want to skip my ocrelizumab for that long on the hope that the vaccine might come in a certain time frame.
      Potential benefit against SARS-CoV-2 vs very likely downside on MS seems like a bad tradeoff to me. The only thing that might be worth considering is switching to DMF but presumably that is a road mostly uncharted…

  9. But perhaps fingolimod will help treat the virus as trials are underway so perhaps if on that treatment you do not need a vaccine
    The options long-term seem to be either treat your Ms or or vaccinate against the virus but you can’t do both
    If you choose to treat your Ms you need to pray for herd immunity and stay at home until that happens so the Ms treatment needs to be tablets

  10. I have been in self isolation since this started and an exit strategy for pwMS is a real concern.
    I am a 53 year old man with rrMS. Diagnosed in 1999 by Prof.G. and went on to Avonex for many years. Later moved onto Fingolimod by local hospital neuro, and still take this.

    I also have asthma.
    I had a recent text from the nhs saying that because I had a flu jab, I am now more at risk.
    I had an email from my MS nurse specialist telling me to stop taking Fingolimod if I get Covid 19 symptoms…with no mention of the serious risk of bounce back relapse and no restarting strategy for risks.

    Now reading about how being on Fingolimod could inhibit any future vaccine, the idea of an exit strategy that lets me leave the house, let alone get back to face to face activities, take a holiday or ever travel abroad seems very unrealistic – I work(ed) in education and coach(ed) kids sports.

    It feels like my current choices are to stay in isolation, not seeing any family or friends indefinitely v’s the Russian roulette of herd immunity – catching covid 19 and hoping not to die from it.

    Thank you for all the updates and information. It is of much more use to me than the daily Government propaganda briefing.

  11. I don’t think the Government has a strategy. They are mostly fired fighting and hoping for the best. As are most governments, since no one yet knows how this pandemic will behave in the fullness of time, whether people can become immune, whether a vaccine can be developed.

    All speculation.

  12. Thank you for this post and also for the many responses. It has got me thinking. My neurologist stopped my second infusion of ocrelizumab until he has a better idea of how the virus is going to play out. My MS activity was detected through my neurofilament light chain level. I am 59, in a wheelchair and hoping to prevent other nasty things from happening. I suppose I would continue to read and deeply consider his continued advice. And, by the way, I am an American who thinks Bill Gates is a hero as is Dr. Fauci and the current occupant of the White House is responsible for the deaths of thousands of my fellow citizens.

    1. Do you actually live in America I only ask because you are in a wheelchair and have managed to get ocrelizumab

      1. Yes, I do live in America. Maryland. My neurologist is at Johns Hopkins. The first go around I had to fight with insurance and lost. So private pay. Gulp. My husband works at a different law firm with different insurance, and it appears that it may be covered for the six-month infusion. We can always hope.

  13. This might be a really stupid question, but if on anti cd20 vaccine responses are blunted, how do we create antibodies while on these drugs?

  14. I am very confused as to what I should be doing at the moment. I have RRMS, which has recently been described as ‘aggressive’. Until February 2019 I was taking Fingolimod, however I had a relapse at that time which hospitalised me and my neurologist stopped Fingolimod (at that time my lymphocytes were 0.3). I decided to switch to Cladribine, but had to wait for my lymphocytes to hit 1.0. During that time I had another relapse (November 2019) and there were changes on my brain MRI. Whilst waiting for my lymphocytes to recover, I have suffered a chronic skin infection , which lowered my lymphocytes again. I finally hit 0.9 just as Covid pandemic began, so I was not allowed to start Cladribine. My MS nurse suggested I start Tysabari instead, but I now find I have recurrent/persistent UTIs which precludes me starting Tysabari. Now I am told that my hospital does not want to start any new patients on infusions.
    My question is, in light of new discoveries about Covid and DMTs, should I consider Tysabari, or would that put me at increased risk if I caught Covid?
    Would starting Tysabari affect the efficacy of any vaccine that may be produced?
    Will Cladribine ever be an option, during the Covid pandemic, even if we come out of lockdown and would starting it put me at greater risk or affect a vaccine?
    I have had no treatment for my MS for 14 months, should I start a treatment as soon as possible or continue as I am. Currently my lymphocytes are 0.9 so I am in a better position if I did catch Covid, but at what risk to my MS?

  15. Thank god for some sanity. Looking at those protesting in large groups to stop the shutdown will not doubt have exposed themselves to a deadly virus that shows no mercy in order to survive and thrive at the expense of the host. Err sounds farmiliar.

  16. Even if the virus response is blunted, I don’t see any reason to change DMT

    At the moment we have strict social distancing, so the chances of getting infected are low

    My plan when lockdown restrictions reduce
    – see to what extent it’s possible to continue working from home
    – avoid public transport, avoid large crowds (earlier I always tried to USE public transport)
    – make it a habit to always wear a mask
    – continue with washing hands repeatedly
    – continue sanitizing doorbells etc
    – avoid shaking hands etc

    Such measures (listed above), will have two consequences

    – one will be exposed to a lower viral load. As a result, if/when one gets infected, the infection is more likely to be mild and self-limiting.
    (Learnt about viral loads from Dr Siddhartha Mukherjee’s recent articles)

    – if many/all take similar measures, the rate of new infections should stay low. The coronavirus hospitals should be able to deal with the serious cases

    Does the above make sense?

    1. Thank you! I can’t speak to the scientific aspects of your post, but it is a remarkable reentry list.

  17. The only class of drugs that have been found to be effective against SAR-CoV replication are the beta-interferons.

    In an in vitro study (Hensley LE, Fritz EA, et al. Interferon-beta 1a and SARS Coronavirus replication. Emerg Infect Dis. 2004; 10(2): 317-319. 10.3201/eid1002.030482.) published on beta-interferons and SARS-CoV replication, it was shown that the virus was inhibited by beta-interferon-1a. Vero E-6 cells were treated with concentrations (5,000 to 500,000 IU/mL) of IFN-β 1a either 24 h before or 1 h after inoculation with the SARS-CoV and monitored for cytopathic effect and production of infectious SARS-CoV at 24, 48, and 72 h post-infection. Inhibition of the SARS-CoVs by IFN-β 1a was dependent on both time of drug administration and time of culture sampling after SARS-CoV infection. Production of infectious SARS-CoV was inhibited (≥99.5% or 2.00 log10 PFU/mL) at 24 h post-infection. I propose that it is time to revisit this class of drugs and consider the use of beta-interferons in MS as first line drugs amid the CoVID 19 pandemic.

    I am not sure why these class of drugs, which are perhaps the only class of drugs found to have activity against SARS-CoV, have not been elevated to the ‘top of the charts’ in MS therapies during this pandemic.

  18. Also, an important and relevant story about the case-fatality rate (CFR) of CoVID 19 is 0.01% according the Stanford U Professor of Medicine and a PhD in Economics (Dr Jay Bhattacharya). This is totally different from the earlier estimates of 0.1% CFR by Dr A Fauci. Looks like Dr Bhattacharya is correct. So, the excessive and heavy-handed shutting down of every moving creature across the globe was perhaps an overkill but read below!

    Meanwhile, it is ALSO correct that the R0, which refers to transmissibility of the virus remains a real threat and it can spread like wild fire. It is still spreading like wildfire in certain parts of the globe and perhaps there is a second or third wave in the future although Ab testing may tell us where we are, to a degree. Hospitals may continue to be overwhelmed because of the R0 characteristic of CoVID 19 but it is comforting to know that CFR is 0.01% and NOT 0.1%. Huge difference.

    Lymphopenia could be a feature of the SARS infection as well as necrosis of the spleen and lymph nodes which are bad news for MS patients. Either way, the choice of DMTs during the pandemic and beyond has to be centered around beta-interferons (see my earlier post) at least till we are back to choosing DMTs based on efficacy, side-effect profile(s), age of patients, and a host of other factors that we usually consider.

  19. Okay, I understand that certain drugs may blunt vaccine responses, but that doesn’t necessarily mean that you won’t get any response
    There are lots of people who are immunosuppressed for many reasons, e.g. have had transplants, have HIV, taking immunosuppressants for MS, RA, crohn’s etc and every year it is recommended that they get the influenza vaccine, and sometimes a second dose because their response is likely to be blunted
    By the time there is a vaccine there should also be a decent antibody test, so people could be vaccinated and then tested to see if they had sero-converted, and if necessary vaccinated again.
    I really don’t think that the fact that vaccination response may be blunted is necessarily a reason not to choose a DMT…. just something else to be aware of when you make the choice, and also something else to think about when you are vaccinated.

  20. This is fantastically helpful – thank you for the amazing work you are doing in providing clear, evidence based information.

  21. Hello Prof G, and thank you and your staff for all the priceless ongoing info. I’m here in Trump-land, which adds an extra excitement (variable) to the whole thing! I’ll answer your question in short and long form, as what you have discussed definitely has been on my mind.
    SHORT ANSWER- Yes, I believe I am covid vulnerable. I halted my ocrevus earlier this year (March 13, Friday, no less) and am debating whether to go back on it in June when I see my MS Doc, when we know more about what is going on. Because I am 62 with several partial vulnerabilities, I’m thinking- weighing the current pros and cons, that being better able to withstand covid in the future is more important, as I have already done well MS wise. I think I have more to lose with covid, then with MS. I do want to be prepared to benefit from a vaccine but realize it is far off. I’m am 50-50 on continuing MS treatment, understanding that it may preclude a favorable response to a vaccine.

    MORE DETAIL, BRIEF HISTORY- first mild symptom 1988, moving thru vision losses, sensory, bladder, balance, leg strength issues, until 1995, then a new MS specialist, strong steroids, betaseron and low fat Swank-ish diet (my preference). All relapsing remitting. One more issue with leg spasms (seemingly) as a result of new neurologist, a quick switch to Avonex, and then back to betaseron on my insistence. No issues thru 2015, MRI or clinical. No relapses, no progression. Then a slow secondary progression involving bladder, balance, and leg spasm and strength issues, seemingly stuff slowly recurring from what had happened earlier (and not remitting). All in all, not too bad, still active and walking (no running), using a cane when worn out.

    MORE DETAIL, CONSIDERATIONS- I was on ocrevus for the first, two 1/2 infusions, knowing that I am neither relapsing remitting or primary progressive, but hoping with my doctor that there may be a benefit for secondary progressive anyway. So I do not consider it an urgent, “do or die” situation as I did back in the early 90’s when all this was beginning, I was freaking out then, and there were no DMTs.
    It’s hard to know what covid is and does. Horror stories of quick death, and also symptom free stories (like the 500 positive but symptom free sailors on the aircraft carrier; what’s up with that?)
    Different DMT’s have a different interaction with covid, and the descriptions of those with ocrevus vary. I have heard nothing conclusive. The general “theme” I am left with, is that it’s probably not much of an issue if everything else is going well and you are young.
    In the struggle to understand DMTs + covid, and adding to my confusion, I am also aware ocrevus and/or other DMTs may help keep your immune system from freaking out against you, leading to a form of severe covid, which is sort of like MS (immune system versus the body).

    MORE DETAIL, VULNERABILITIES- and I say all this not only from a “clinical” point of view, but from the point of view of not wanting to be the victim of a judgment, from an over zealous or otherwise incompetent Doctor I don’t know, reading my health record and trying to figure out who gets the last ventilator, me or the other guy in the hallway, neither of us breathing very well.
    *I am pre-diabetic, with numbers coming in consistently around 105 or lower.
    * My BP is stable, 120/80, controlled by slight medication. (normal weight)
    * I have kidney cysts of unknown origin (not PKD). My gfr is in the high 70’s.
    * I have been a light smoker since 2000. Quitting today will have no impact. I had already planned to totally quit at 64.
    * I am 62.
    * wife still working at an essential job. Good health habits there, but will she bring it home anyway?

    SO IN CONCLUSION, a working vaccine when it becomes available is very important to me, and it is one factor among many which will influence my choice to continue or discontinue ocrevus. -While I am not at all falling apart and have fared well overall and am still faring well, might I be one of those people who gets covid and rapidly deteriorates? I don’t want to find out. Is covid avoidable? Probably not, but I’ll try. So avoiding covid as long as possible might keep me away from an overwhelmed hospital, if it gets that bad, and keep the answers to my other questions from being answered as well. Not being on ocrevus won’t kill me. Getting covid might. A proven vaccine will help when it comes out. But I have to get thru today to get to tomorrow. Things might change. I’m 50-50, wish I could be more certain. There’s a lot of stuff to take into account. I’ll talk to my MS Doc in June. Tom

  22. Can I get some more clarity on this portion of the above blog?

    “Surprisingly, antibody response to common vaccines occur on anti-CD20 therapies, but antibody response to glycoprotein vaccines, for example, the pneumococcal vaccine are blunted or inhibited the most. This may be particularly relevant to a SARS-CoV-2 vaccine that is likely to require antibodies to glycoprotein antigens to generate neutralizing antibodies”

    Why is the vaccine response with anti-CD20’s blunted more with glycoprotein vaccines?

    1. Anti-CD20 therapies disrupt germinal centres, where affinity maturation occurs and B-cell get pro-survival signals from antigens. Germinal centres select B cells clones with the highest avidity and this is important for glycoproteins, which have complex 3D structures.

    2. Glycosylation is an escape mechanism for the virus as it appears to be harder for the immune sytem to see. the COVID-19 is heavily glycosylated

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