How do you approach the timing of COVID-19 vaccination for patients with multiple sclerosis on B-cell depleting therapies?

B-cell depleting agents can interfere with a patient's ability to develop an adequate humoral response. With regards to the infusions such as rituximab and ocrelizumab, I recommend holding off on getting SARS-CoV2 vaccinations until at least 3 months and up to, at minimum, 2 weeks prior to the next ...

If you are about to start Ocrevus or Rituxan, consider getting fully vaccinated* 2-4 weeks or more prior to starting the infusions. If you are already taking Ocrevus or Rituxan, consider getting vaccinated 12 weeks or more after the last DMT dose (The VELOCE study. Bar-Or et al., PMID 32727835).

I absolutely agree with the recommendations about when to give immunizations if a patient has not started B-cell depleting therapy yet (ideally 2-4 weeks prior to starting B-cell depleting agent). In those that are already on therapy, I think the answer is much less clear and I have seen no compelli...