Share Impact of disease-modifying treatments on humoral response after COVID-19 vaccination: A mirror of the response after SARS-CoV-2 infection.Bigaut K, Kremer L, Fleury M, Lanotte L, Collongues N, de Seze J.Rev Neurol (Paris). 2021 Jun 16:S0035-3787(21)00569-5.
Objective: To analyze the humoral response after COVID-19 vaccination in patients with multiple sclerosis (MS) according to disease-modifying treatments (DMTs) and in comparison with the humoral response after SARS-CoV-2 infection. Methods: We included 28 MS patients with serological results after COVID-19 vaccination (Pfizer-BioNTech or Moderna ARNm) and 61 MS patients with serological results after COVID-19 (COVID-19 group) among patients followed up at the MS Center of Strasbourg, France, between January and April 2021. The primary endpoint was the IgG index according to DMTs (anti-CD20 mAb, sphingosine 1-phosphate receptor [S1PR] modulator and other treatments) and COVID-19 vaccine or COVID-19 groups. Results: In the vaccinated MS patients, the median IgG index was lower in patients treated with anti-CD20 mAb and in patients treated with S1PR modulator compared to patients receiving other or no DMTs (4.80 [1.58-28.6], 16.5 [16.3-48.5], 1116 [434-1747] and 1272 [658-1886], respectively, P<0.001). Similar results were found for MS patients after COVID-19. Conclusions: Patients with MS and treated with S1PR modulators or anti-CD20 mAb had a reduced humoral response after COVID-19 vaccine.
“Although the size of the population is very small and so, interpretation should be taken with caution, a time from the last infusion of anti-CD20 mAb higher than 4 months seems to play a role in the humoral response after vaccination”.
I would be cautious about the 4 months cut-off. We have to ask what CD20 was used, they are no the same…rituximab maybe ocrelizumab I doubt it will be optimized at 4 moths.
There is a French study aiming to look at 10,000 people including 600 neurological patients….starting March 2021 NCT04824651…planed end date 2024. I have to say by this time, we will really have lost interest. However further support for COVID-19 vaccination issues with ocrelizumab and fingolimod
Arrambide G, Llaneza-González MÁ, Costa-Frossard França L, Meca-Lallana V, Díaz EF, Moreno-Torres I, García-Domínguez JM, Ortega-Suero G, Ayuso-Peralta L, Gómez-Moreno M, Sotoca-Fernández JJ, Caminero-Rodríguez AB, Rodríguez de Antonio LA, Corujo-Suárez M, Otano-Martínez MA, Pérez-Miralles FC, Reyes-Garrido V, Ayuso-Blanco T, Balseiro-Gómez JJ, Muñoz-Pasadas M, Pérez-Molina I, Arnal-García C, Domingo-Santos Á, Guijarro-Castro C, Íñiguez-Martínez C, Téllez Lara N, Castellanos-Pinedo F, Castillo-Triviño T, Cerdán-Santacruz DM, Pérez-Sempere Á, Torres BS, Álvarez de Arcaya A, Costa-Arpín E, Durán-Ferreras E, Fragoso-Martínez M, González-Platas M, Landete Pascual L, Millán-Pascual J, Oreja-Guevara C, Meca-Lallana JE. SARS-CoV-2 Infection in Multiple Sclerosis: Results of the Spanish Neurology Society Registry. Neurol Neuroimmunol Neuroinflamm. 2021 Jun 24;8(5):e1024
Objective: To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments.
Methods: Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome.
Results: Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. (but it is hardly much difference with odds ratio of 1.09 so about 10% worse).
Conclusions: This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal disease.
If they had read our review (Baker D, Amor S, Kang AS, Schmierer K, Giovannoni G. The underpinning biology relating to multiple sclerosis disease modifying treatments during the COVID-19 pandemic. Mult Scler Relat Disord. 2020 Aug;43:102174. doi: 10.1016/j.msard.2020.102174. Epub 2020 May 12) on the role of MS therapy on COVID-19 they may not have been surprised to see that the study ” did not demonstrate a critical role of MS therapy on COVID-19 course”. They found “Compared with ambulatory cases, patients with severe or critical disease were more likely to be older, male, have a longer MS duration, higher EDSS scores, and a progressive MS course”
However, whilst anti-CD20 and sphinogosine-1-phosphate modulators continue to take a bashing when it comes to their vaccination response and response toinfection, cladribine continues to look good.
MS and COVID-19 challenge: asymptomatic COVID-19 infection during treatment with cladribine.Seferoğlu M, Ethemoğlu Ö, Turan ÖF, Siva A.Neurol Sci. 2021 Jun 24:1-3. doi: 10.1007/s10072-021-05409-6.
Background: The use of disease-modifying therapies (DMTs) in people with multiple sclerosis (pwMS) may affect COVID-19 infection outcomes due to DMTs’ immunomodulatory and immunosuppressive effects on immune response. The yet unknown issues are both the early response to the infection, as well as the post-infection development of immunity against the virus under these treatments due to their interaction with the immune system. Methods: We report two asymptomatic cases of COVID-19 in patients with relapsing-remitting multiple sclerosis (RRMS) shortly after starting cladribine therapy, both developed anti-SARS-CoV-2 antibody response. Results: Patients with MS who are under newly initiated treatment with cladribine tablets may experience an asymptomatic COVID-19 infection and they may develop immunity against SARS-CoV-2. Conclusion: These observations raise the probability that DMTs with immunosuppressive effects, such as cladribine, may be considered as a treatment option for selected MS patients with high disease activity during the COVID-19 pandemic.
These people were infected shortly (with a month) after their cladribine doses. They were asymptomatic and made an antibody response and is consitent with the vaccination data presented at ACTRIMS.
General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.