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. 2022 Feb 22;93(9):978–985. doi: 10.1136/jnnp-2021-328197

Figure 2.

Figure 2

Attenuated humoral immune response to SARS-CoV-2 vaccination in patients with MS receiving ocrelizumab. (A) Box plot analysis of anti-SARS-CoV-2(N)-abs and anti-SARS-CoV-2(S)-abs at BL and F/U: Lower quartile, median and upper quartile are illustrated by boxes. Whiskers show the min and max values. Individual values are depicted by black dots. Values<0.1 U/mL (anti-SARS-CoV-2(N)) and <0.4 U/mL (anti-SARS-CoV-2(S)) are depicted on the x-axis. Cut-off values are illustrated by dashed red lines. (B–E) Correlation of anti-SARS-CoV-2(S)-abs with peripheral B cell counts (B), time since last infusion (C), total IgM levels in PB (D), and number of previous treatment cycles (E). Correlation analysis was performed with the Spearman correlation coefficient. The area in between the dotted lines shows the 95% CI. B cell counts <10 /µL are depicted on the y-axis and anti-SARS-CoV-2(S)-abs<0.4 U/mL are shown on the x-axis. (F) Box plot analysis comparing the amount of peripheral CD20 B cells and plasma cells (assessed by mFC) at F/U between patients with and without anti-SARS-CoV-2(S)-abs: Lower quartile, median and upper quartile are illustrated by boxes. Whiskers show the min and max values. Individual values are depicted by black dots. (G) Box plot analysis comparing the amount of peripheral plasmablasts (assessed by mFC) at F/U between patients with anti-SARS-CoV-2(S)-abs despite depleted peripheral B cells and patients without abs and depleted B cells: Lower quartile, median and upper quartile are illustrated by boxes. Whiskers show the min and max values. Individual values are depicted by black dots. ab(s), antibody(ies); BL, baseline; F/U, follow-up; Ig, immunoglobulin; max, maximum; mFC, multidimensional flow cytometry; min, minimum; MS, multiple sclerosis; N, nucleocapsid; neg., negative; OCR, ocrelizumab; PB, peripheral blood; pos., positive; S, spike.