Patients with multiple sclerosis (MS) should carefully select the time that they receive the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, according to a study recently published in Neurology Neuroimmunology & Neuroinflammation.

“We were able to show that T-cellular responses to vaccination are increased in anti-CD20–treated as compared to immunocompetent [people with MS] when vaccination takes place within 31–90 days after the last [B-cell–depleting treatment (BCDT)] pulse,” the authors wrote.

This cross-sectional study included 160 patients previously diagnosed with MS. Of these, 133 patients were currently receiving pulsed BCDT, and 132 of them used ocrelizumab; the other patient used rituximab. The remaining 27 participants did not have an ongoing disease-modifying therapeutic scheme.

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The researchers analyzed humoral and cellular responses to the SARS-CoV-2 vaccine, correlating them with the time of administration. Interestingly, the greatest cellular and humoral activities were achieved at differing times since the last treatment administration.

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Patients showcased an increased humoral response when they received the vaccine a longer period of time after the last BCDT. As expected, the CD19 lymphocyte count increased with higher humoral activity. Conversely, both the CD4 and CD8 T-cell responses were greater when the vaccine was administered shortly after the BCDT.

“In other words, the enhanced T-cell response was observed in the group of patients on BCDT who were not only B cell depleted but also assumed to have a higher degree of depletion of CD20 T cells compared with the other analyzed BCDT groups,” the authors explained.

Furthermore, a past history of coronavirus disease 2019 (COVID-19) led to expanded T-cell and humoral responses.

These results challenge the current recommendation of delaying BCDT in an effort to increment the humoral activity against the SARS-CoV-2 vaccine. The decision regarding the timing of vaccination should be adapted for each case. For example, an early administration may be beneficial in patients who should not delay BCDT.


Woopen C, Dunsche M, Haase R, et al. Timing of SARS-CoV-2 vaccination matters in people with multiple sclerosis on pulsed anti-CD20 treatment. Neurol Neuroimmunol Neuroinflamm. Published online October 12, 2022. doi:10.1212/nxi.0000000000200031