MS – Vaccination on Anti-CD20 Therapy — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Vaccination on Anti-CD20 TherapySCE Neurology

A 42-year-old woman with RRMS on ocrelizumab is scheduled for a COVID-19 booster vaccination. When should the vaccine ideally be timed relative to her ocrelizumab infusions?

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Correct answer: C — At least 3 months after the last infusion and at least 4 weeks before the next infusion

Anti-CD20 therapies (ocrelizumab, rituximab) deplete B cells and impair vaccine responses. To maximise immunogenicity, inactivated vaccines should ideally be given at least 3 months (12 weeks) after the last infusion and at least 4 weeks before the next dose, allowing partial B-cell reconstitution. Live vaccines are contraindicated on ocrelizumab. A: Immediately before infusion means B cells are still depleted. C: Timing significantly affects vaccine efficacy. D: All vaccines need timing consideration on anti-CD20 therapy, not just live ones. E: Inactivated vaccines are not contraindicated, though response may be blunted.

Reference: ABN MS Guidelines (2022); Ocrelizumab SmPC; NICE TA533