The humoral response becomes impaired after COVID-19 vaccination in patients with neuromyelitis optica spectrum disorder (NMOSD) treated with B-cell depleting therapies, a new study published in Multiple Sclerosis and Related Disorders found. However, seroconversion occurred in almost all patients treated with conventional synthetic disease-modifying immunosuppressants after COVID-19 infection or vaccination.

The authors of the study concluded that vaccination against SARS-CoV-2 infections may still be useful in patients with NMOSD, especially those treated with B-cell depleting therapies given the importance of cellular immune response after immunization.

To evaluate the humoral response in patients with NMOSD who had COVID-19 or were vaccinated against the disease, a team of researchers led by Jelena Drulovic MD, PhD, from the University of Belgrade in Serbia measured serum levels of immunoglobulin G against the receptor-binding domain of the virus’ spike protein.

Continue Reading

Read more about the treatment of NMOSD

The results showed that seroconversion occurred in 8 out of 10 patients who had COVID-19. This number was 5 out of 9 for patients after vaccination. Of the 4 patients with NMOSD who were treated with the B-cell depleting therapy inebilizumab, 1 had seroconvertion following COVID-19 infection. None of the other 3 patients who had been vaccinated had detectable antibodies in their serum.

In the case of 5 patients treated with azathioprine, 4 developed antibodies after a COVID-19 infection as did all those treated with mycophenolate mofetil. Five of the 6 patients who were treated with these medications had antibodies after vaccination.

Patients with NMOSD usually experience repeated attacks separated by periods of remission. There are 4 types of treatments that are used to prevent the recurrence of attacks in patients with NMOSD: traditional immunosuppressive treatment such as azathioprine and mycophenolate mofetil, IL-6 pathway inhibitors, complement-blocking therapy, and B-cell-depleting therapy like inebilizumab.


Jovicevic V, Ivanovic J, Momcilovic N, et al. Humoral response to SARS-CoV-2 infection and vaccines against COVID-19 in patients with neuromyelitis optica spectrum disorders: impact of immunosuppressive treatment. Mult Scler Relat Disord. Published online April 6, 2022. doi:10.1016/j.msard.2022.103794