What’s the latest on people with B cell depleters (rituxan) and COVID vaccines, and what about Evusheld?

Here is My Question:
What’s the latest on people with B cell depleters (rituxan) and vaccines? I had th J&J shot and then a booster. Do I need a third? Also what’s the MS neurology opinion on Evushield or other monoclonals? Can we access? And if so what’s the timing recommended?

Answer:
People with MS who are receiving treatment with S1P modulators (Gilenya, Mayzent, Zeposia, Ponvory) and lymphocyte depleting agents (e.g. rituximab, Ocrevus, Kesimpta, Lemtrada and Mavenclad) may have an impaired antibody response to COVID19 vaccination. Whenever possible, vaccination should be completed prior to commencing therapy or after stopping the DMT for a time interval that is dependent of the specific therapy. You should never stop any of these DMTs, even briefly, without first discussing the safety and advisability of doing so with your MS specialist. Decisions regarding the timing of vaccination and altering treatment are highly complex and depend on your MS risk factors as well as your risk of severe COVID19 infection.

Per press release, AstraZeneca's Evusheld (tixagevimab co-packaged with cilgavimab) is a long-acting antibody (LAAB) combination with emergency use authorisation (EUA) in the US for the pre-exposure prophylaxis (prevention) of COVID-19. Availability is expected to be limited.

The Food and Drug Administration (FDA) granted the EUA for Evusheld for pre-exposure prophylaxis of COVID-19 in adults and adolescents (aged 12 and older who weigh 40kg or more) with moderate to severe immune compromise due to a medical condition or immunosuppressive medications and who may not mount an adequate immune response to COVID-19 vaccination, as well as those individuals for whom COVID-19 vaccination is not recommended. 

Stay tuned for more information.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego