Editors' Note: Effect of Ocrelizumab on Vaccine Responses in Patients With Multiple Sclerosis: The VELOCE Study
Dr. Bar-Or and colleagues report the findings of the VELOCE multicenter randomized clinical trial, which evaluated the serologic response to vaccinations in patients with multiple sclerosis (MS) treated with the B-cell depleting agent, ocrelizumab. In this trial, patients with relapsing remitting MS were randomized to (1) ocrelizumab or (2) control (no disease modifying therapy or the use of interferon beta—which has limited effect against immunizations). The primary efficacy end point of a positive serologic response to tetanus toxoid was no different between the treatment or control groups, although control patients demonstrated a more robust response to immunization. The same serologic responses were observed between treatment groups using influenza, pneumococcal, and neoantigen vaccines. Nicole Hahn expresses concern regarding the sequence of the pneumococcal vaccinations, which is inconsistent with CDC recommendations. Dr. Bar-Or and colleagues explain that their approach (using PCV13 as a booster after PPSV23 at 4 weeks, rather than at a minimum of 8 weeks later) was intentionally used to evaluate T-cell dependent and independent pathways, rather than to evaluate the vaccination paradigm in patients with MS on ocrelizumab.