Immune Response in the Management of MS - Episode 11
Clinical implications from VELOCE, a phase 3b study examining the effect of ocrelizumab on immune responses in patients with relapsing MS.
Ahmed Z. Obeidat, MD, PhD: Dr Hendin, I’m going to talk to you about the other study published earlier called VELOCE. That study looked at ocrelizumab in relation to immune responses to specific types of vaccinations. At the time, there wasn’t a COVID-19 vaccination. Would you talk about the main result and message from the study?
Barry A. Hendin, MD: There are 2 arms to the vaccination response. One is the humoral response, which is the immunoglobulins. The other is the T-cell response. The more we learn about immunity, the humbler we are about the fact that clinical outcomes are what matter. These give us some insight. It’s clear that the B-cell depletion therapies have a less robust humoral response. That’s consistent across multiple studies. As you and Regina pointed out, the S1P receptor modulators also have a less robust humoral response. The fact that there’s still a benefit from these vaccinations—and I’m going back to COVID-19—probably relies on the fact that the immune response is multiphasic and includes the cellular response. We’re always hoping the cellular response provides some degree of vaccination response, even if imperfect.
Unless there’s a serious reason not to, I want all my patients to be vaccinated, whether they’re on a B-cell depletion therapy, an S1P [receptor] modulator, or any other agent. I have to talk to my patients on B-cell depletion therapies about potential risk in the era of COVID-19. But even there, I always remind them of the risk of MS [multiple sclerosis] which, if untreated or undertreated, exceeds the risks of the therapies we use.
Ahmed Z. Obeidat, MD, PhD: To emphasize the point, there are some attenuated responses, but the conclusion of the authors of the VELOCE study was to encourage vaccination in general because some response is better than nothing. This is the whole message, and it’s important to share it with our patients. These are some of the practical points when patients ask us about this. They ask, “Do you know about this study?” I say, “Yes. This is our interpretation of the data.”
Transcript Edited for Clarity