Varicella zoster immunity loss in multiple sclerosis patient treated with ocrelizumab

• Published in: Clinical immunology (Orlando, Fla.) Fla.), 2021-02, Vol.223, p.108554-108554, Article 108554
• Main Authors: Rapisarda, L., Valentino, P., Barone, S., Torti, C., La Gamba, V., Fortunato, F., Sammarra, I., Gambardella, A.
• Format: Article
• Language: English
• Subjects: Immunity; Multiple sclerosis; Ocrelizumab; Varicella zoster
• ISSN: 1521-6616; 1521-7035
• DOI: 10.1016/j.clim.2020.108554

Ocrelizumab is a novel humanized anti-CD20 antibody used for treatment of relapsing remitting and primary progressive multiple sclerosis with evidence of inflammatory activity. Guidelines suggest assessing vaccination status and eventually vaccinate patients with multiple sclerosis before new disease modifying therapy initiation. However, there are not any specific recommendations about vaccinal immunity reassessment after ocrelizumab injection. We describe the case of a patient who loss varicella zoster vaccinal immunity after the first ocrelizumab infusion. It is advisable to reassess vaccinal immunity to isolate non-immune patients and to adopt suitable preventive measures, including close contacts vaccination and avoidance of contacts with active infection. •Vaccination should be updated before any DMT.•Live-attenuated vaccines are contraindicated during immunosuppression and, of course, during anti-CD20 treatment.•Immunization decreases over age.•Cocooning strategy should be recommended in case of contraindication for updating vaccinations in negative patients.•Anti CD-20 treatment decreases vaccines efficacy.