Abstract
Background and purpose: Recent findings document a blunted humoral response to SARS-CoV-2 vaccination in patients on anti-CD20 treatment. Although most patients develop a cellular response, it is still important to identify predictors of seroconversion to optimize vaccine responses.
Methods: We determined antibody responses after SARS-CoV-2 vaccination in a real-world cohort of multiple sclerosis patients (n = 94) treated with anti-CD20, mainly rituximab, with variable treatment duration (median = 2.9, range = 0.4-9.6 years) and time from last anti-CD20 infusion to vaccination (median = 190, range = 60-1032 days).
Results: We find that presence of B cells and/or rituximab in blood predict seroconversion better than time since last infusion. Using multiple logistic regression, presence of >0.5% B cells increased probability of seroconversion with an odds ratio (OR) of 5.0 (95% confidence interval [CI] = 1.0-28.1, p = 0.055), whereas the corresponding OR for ≥6 months since last infusion was 1.45 (95% CI = 0.20-10.15, p = 0.705). In contrast, detectable rituximab levels were negatively associated with seroconversion (OR = 0.05, 95% CI = 0.002-0.392, p = 0.012). Furthermore, naïve and memory IgG<sup>+</sup> B cells correlated with antibody levels. Although retreatment with rituximab at 4 weeks or more after booster depleted spike-specific B cells, it did not noticeably affect the rate of decline in antibody titers. Interferon-γ and/or interleukin-13 T-cell responses to the spike S1 domain were observed in most patients, but with no correlation to spike antibody levels.
Conclusions: These findings are relevant for providing individualized guidance to patients and planning of vaccination schemes, in turn optimizing benefit-risk with anti-CD20.
Keywords: B-cell depletion; SARS-CoV-2; multiple sclerosis; rituximab; vaccination.
【저자키워드】 SARS-CoV-2, multiple sclerosis, rituximab, vaccination., B-cell depletion, 【초록키워드】 Treatment, vaccination, antibody, Antibody Response, T-cell Response, B cells, memory, B cell, Probability, Cohort, Seroconversion, Patient, Logistic regression, predictor, patients, predict, Guidance, Blood, Antibody titers, booster, SARS-CoV-2 vaccination, anti-CD20, B-cell, cellular response, Odds ratio, humoral, vaccine responses, interleukin-13, 95% CI, 95% confidence interval, naïve, no correlation, anti-CD20 treatment, S1 domain, Affect, recent, identify, develop, detectable, median, treated, correlated, turn, IgG^{+}, 【제목키워드】 Efficacy, SARS-CoV-2 vaccine, Patient, B-cell,