The summaries are free for public use. ARTHROS will continue to add and archive summaries of articles deemed relevant to ARTHROS by our Faculty.
Author
Clin Exp Immunol. 2020 Jul 16. doi: 10.1111/cei.13495. Online ahead of print.
David Baker 1, Charles Ak Roberts 1, Gareth Pryce 1, Angray S Kang 1 2, Monica Marta 1 3, Saul Reyes 1 3, Klaus Schmierer 1 3, Gavin Giovannoni 1 3, Sandra Amor 1 4
Author Information
Abstract
Although most autoimmune diseases are considered to be CD4 T-cell or antibody-mediated, many respond to CD20-depleting antibodies that have limited influence on CD4 and plasma cells. This includes rituximab, oblinutuzumab, ofatumumab that are used in cancer, rheumatoid arthritis and off-label in a large number of other autoimmunities, and ocrelizumab in multiple sclerosis. Recently, the COVID-19 pandemic created concerns about immunosuppression in autoimmunity, leading to cessation or a delay in immunotherapy treatments. However, based on the known and emerging biology of autoimmunity and COVID-19, it was hypothesised that whilst B-cell depletion should not necessarily expose people to severe SARS-CoV-2-related issues, it may inhibit protective immunity following infection and vaccination. As such, drug-induced B-cell subset inhibition that controls at least some autoimmunities, would not influence innate and CD8 T-cell responses, which are central to SARS-CoV-2 elimination, nor the hyper-coagulation and innate inflammation causing severe morbidity. This is supported clinically, as the majority of SARS-CoV-2 infected, CD20-depleted people with autoimmunity, have recovered. However, protective neutralising-antibody and vaccination responses are predicted to be blunted, until naïve B-cells repopulate, based on B-cell repopulation-kinetics and vaccination responses, from published rituximab and unpublished ocrelizumab (NCT00676715, NCT02545868) trial data, shown here. This suggests that it may be possible to undertake dose-interruption to maintain inflammatory disease control, whilst allowing effective vaccination against SARS-CoV-29, if and when an effective vaccine is available.