When Having Covid while on Ocrevus, should we expect to gain less protective antibody production, as is the case when getting the vaccine?

Here is My Question:
When getting Covid while on Ocrevus, should we expect to gain less protective antibody production, as is the case when getting the vaccine?

I'm assuming that actual response would be impacted by b levels, from when the infusion took place, etc.?

(We know that b depleting therapies like Ocrevus will inhibit antibody creation when taking vaccines.)

Answer:
There are virtually no systematic studies about SARS-CoV-2 antibody responses post COVID-19 infection in people with MS (pwMS) on different disease modifying therapies, including Ocrelizumab. Most of out information comes from studies of antibody production after vaccination. This information can be summarized as follows:

1. pwMS experience a dramatic decrease in IgG antibody production 4 weeks post vaccination if they are on active treatment with Ocrelizumab or rituximab
2. Antibody responses to vaccination are better the longer the interval since last infusion
3. One recent study suggested that antibody responses to SARS-CoV-2 vaccination may be higher with the Moderna mRNA vaccine, but this has not been replicated.

It is important to remember that you can not assume a SARS-CoV-2 antibody response will be protective against infection. Many arms of the immune system not measured with an antibody assay, especially T cell mediated immunity, are important in the immune response that creates protective immunity. Furthermore, not all antibodies are able to neutralize the SARS-CoV-2 virus, a step necessary for protection. There are studies showing an association between IgG antibodies directed against the spike protein and the ability to neutralize the virus, but this type of neutralizing antibody assay is not routinely done in clinical practice.

We continue to recommend  updated SARS-CoV-2 boosters in pwMS on anti-CD20 therapy. Many sources recommend waiting at least 3 months after an infusion to get a booster, but it is likely that your immune response to vaccination will improve if you can wait 6 or more months or obtain an additional booster when you are able to be off anti-CD20 therapy for more than 6 months.  

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