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Does the effectiveness of the COVID-19 vaccines differ based on duration of treatment with a B-cell depleting drug?

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Key Takeaway: While more study is needed, there appears to be a decreased antibody response the longer someone has been on Sphingosine 1-phosphate receptor modulators (Gilenya®, Mayzent®, Zeposia®, Ponvory™) and anti-CD20 therapy (Ocrevus®, Kesimpta®, Rituxan® and biosimilars).

Research about COVID-19 continues to provide new information about the virus and its impact on people with MS. The information on this page was accurate at the time it was last updated on July 25, 2023.


One study (Satyanarayan et al. 2022) found that 72.4% of people on Sphingosine 1-phosphate receptor modulators had an antibody response from COVID-19 vaccination. However, a longer treatment duration (an average of 2274 days) was associated with not having an antibody (or “B-cell”) response. B-cells are a type of blood cell that create antibodies. B-cells are responsible for the initial immune response against a COVID-19 infection.

This study also found that only 37.6% of people with MS on anti-CD20 monoclonal antibody therapy had a positive antibody response after COVID-19 vaccination. People who had been on anti-CD20 therapy less than a year had a greater chance of a positive antibody response compared to those on the therapy a year or longer.

Other studies also confirm the association between length of time on these two types of therapies and reduced antibody response.

It is important to note that vaccination may still create a T-cell immune response, which helps reduce severe illness and hospitalization from COVID-19 infection. T-cells directly destroy infected cells and help reduce severe illness and hospitalization from COVID-19 infection. Few studies have assessed levels of T-cell immunity.

If you are taking the following disease modifying therapies (DMTs), discuss with your medical team the best COVID-19 vaccination and booster strategy:

  • Sphingosine 1-phosphate receptor modulators (Gilenya®, Mayzent®, Zeposia®, Ponvory™)
  • Alemtuzumab (Lemtrada®)
  • Anti-CD20 monoclonal antibodies (Ocrevus®, Kesimpta®, Rituxan® and biosimilars)


  • Satyanarayan, S., Safi, N., Sorets, T., Filomena, S., Zhang, Y., Klineova, S., ... & Sand, I. K. (2022). Differential antibody response to COVID-19 vaccines across immunomodulatory therapies for multiple sclerosis. Multiple Sclerosis and Related Disorders, 62, 103737.
  • Holroyd KB, Healy BC, Conway S, Houtchens M, Bakshi R, Bhattacharyya S, Bose G, Galetta K, Kaplan T, Severson C, Singhal T, Stazzone L, Zurawski J, Polgar-Turcsanyi M, Saxena S, Paul A, Glanz BI, Weiner HL, Chitnis T. (2022). Humoral response to COVID-19 vaccination in MS patients on disease modifying therapy: Immune profiles and clinical outcomes. Mult Scler Relat Disord. 2022 Nov;67:104079.
  • Sabatino JJ Jr, Mittl K, Rowles WM, McPolin K, Rajan JV, Laurie MT, Zamecnik CR, Dandekar R, Alvarenga BD, Loudermilk RP, Gerungan C, Spencer CM, Sagan SA, Augusto DG, Alexander JR, DeRisi JL, Hollenbach JA, Wilson MR, Zamvil SS, Bove R. (2022). Multiple sclerosis therapies differentially affect SARS-CoV-2 vaccine-induced antibody and T cell immunity and function. JCI Insight. Feb 22;7(4):e156978.