The OCTAVE study results

31 August 2021

The OCTAVE study results were released on 24 August 2021 and we realise that the initial headlines could cause concern and worry. The study looked at vaccine response of those who are ‘immuno-compromised’ which includes a very wide range of people at varying levels of immune-compression. What the study has shown is that compared to people with other conditions those with RA fared better. Most patients responded with 51% with inflammatory arthritis showing a response. We still don’t know how exactly how serology result (B cell response) correlates with protection from severe infection. Some recent experience is that most of the patients and the general population recently/currently infected despite double vaccinated had very mild disease. Virtually all OCTAVE participants had robust T cell response (even those with no/low B cell response) so while it is still unclear the significance of this response it is very encouraging. 

Also reassuring and worth highlighting is that the  UK government and vaccine task force are looking at this closely and high on their priority list is to “ensure those most at risk get the best protection”, so they are definitely not forgotten. There is already a study underway to answer whether 3rd booster will seroconvert non-responders and boost low responders in OCTAVE with early data going to vaccine task force in early-mid Sept to inform their decision-making and prioritisation. 

There still remains some concerns regarding those people being treated on rituximab for their inflammatory arthritis but some “positives” for those already on rituximab are:  [1] the encouraging T cell responses (although don’t know how that translates to protection yet) and [2] the fact that JCVI/government task forces are already actively looking at alternatives for those who do not/cannot respond well to vaccines so even if do not respond well to 3rd booster, there will be options. 

The OCTAVE study and the follow-on OCTAVE -DUO study will over the coming months offer real insight for the many thousands of people who are immune-compromised.  

The real take home message is that ‘some’ protection is certainly better than no protection and there is higher risk of serious consequences of COVID19 if disease is not well controlled. If you have any concerns you should speak to your treating clinician. 

The roll-out of the vaccine programme was extremely important for these vulnerable groups of patients, however due to their underlying medical conditions and treatments, which can weaken their immune systems, we were concerned that people with these medical conditions may not receive optimal protection, so it was, and remains, extremely important to investigate this unanswered question.  

While a proportion of the clinically at-risk patent groups were found to have a low or undetectable immune response after a double dose of the vaccine, the scientists and clinicians involved in the study remain encouraged that most immunocompromised patients, including the majority of inflammatory arthritis patients, did mount a good response after second vaccination. We are keen to support these patient groups as much as possible, and in OCTAVE DUO we have imminent plans in place to investigate the effects of administrating a third, or booster, vaccine dose to the group who showed a low or undetectable vaccine immune response. We hope OCTAVE DUO findings will go on to support the role out of an immunological screening programme for vulnerable patients to identify those who will benefit from a subsequent vaccine boost. We would continue to encourage patients within clinically at-risk groups, including inflammatory arthritis, to make sure they receive both vaccine doses.
Professor Iain McInnes, lead of the OCTAVE and the OCTAVE Duo studies, and Vice Principal of the University of Glasgow 

Click below to join Clare Jacklin, NRAS CEO in conversation with Professor Stefan Siebert of Glasgow University live on Wednesday 29 September at 7pm. The topic of conversation will be to gain a better understanding of what the findings from the OCTAVE study tell us for those living with inflammatory arthritis. 

Click below to find a very informative frequently asked questions document that will offer some clarity. 

Please contact NRAS at 08002987650 or email helpline@nras.org.uk for further information and help.