Sormani, MP et al. COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context. SSRN: https://ssrn.com/abstract=3884934

Background: It is unclear how multiple sclerosis (MS) affects the severity of Covid-19.

Methods: Hospitalization, Intensive Care Unit (ICU) admission and death after Covid-19 diagnosis of 1362 MS patients were compared to the age and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher-risk: EDSS>3 or at least one comorbidity, lower-risk: EDSS<=3 and no comorbidities) by the chi-square test and the risk excess was quantified by Risk Ratios (RR).

Findings: The risk of severe events was about twice the risk in the age and sex-matched Italian population: RR=2·12 for hospitalization (p<0·001), RR=2·19 for ICU admission (p<0·001) and RR=2·43 for death (p<0·001). The excess of risk was confined to the higher-risk group (n=553). In lower-risk patients (n=809) the rate of events was close to that of the Italian age and sex-matched population (RR=1·12 for hospitalization, RR=1·52 for ICU admission, and RR=1·19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR=3·03, p=0·005), while a decrease was detected in patients on interferon (0 observed vs 4 expected events, p=0·04).

Interpretation: Overall the MS cohort had a risk of severe events that is twice the risk in the age and sex-matched Italian population. This excess of risk is mainly explained by EDSS and comorbidities, while a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.

SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression.
Cajamarca-Baron J, Guavita-Navarro D, Buitrago-Bohorquez J, Gallego-Cardona L, Navas A, Cubides H, Arredondo AM, Escobar A, Rojas-Villarraga A.Reumatol Clin (Engl Ed). 2021 Aug-Sep;17(7):408-419. doi: 10.1016/j.reumae.2020.08.001.

Background: It is not clear whether patients with some degree of immunosuppression have worse outcomes in SARS-CoV-2 infection, compared to healthy people. (Not clear yer right)

Objective: To carry out a narrative review of the information available on infection by SARS-CoV-2 in immunosuppressed patients, especially patients with cancer, transplanted, neurological diseases, primary and secondary immunodeficiencies.

Results: Patients with cancer and recent cancer treatment (chemotherapy or surgery) and SARS-CoV-2 infection have a higher risk of worse outcomes. In transplant patients (renal, cardiac and hepatic), with neurological pathologies (multiple sclerosis (MS), neuromyelitis optica (NMODS), myasthenia gravis (MG)), primary immunodeficiencies and infection with human immunodeficiency virus (HIV) in association with immunosuppressants, studies have shown no tendency for worse outcomes.

Conclusion: Given the little evidence we have so far, the behaviour of SARS-CoV-2 infection in immunosuppressed patients is unclear, but current studies have not shown worse outcomes, except for patients with cancer (Should have gone to Spec savers and done abit more reading).

Galleguillos L, Alonso R. Key points to keep in mind related to COVID-19 vaccines in people with multiple sclerosis. Mult Scler Relat Disord. 2021 Jul 16;54:103142. doi: 10.1016/j.msard.2021.103142.

Vaccinations are often the most effective tool against certain diseases known to mankind, and their interaction with multiple sclerosis (MS) has been discussed for decades. With rapidly accumulating numbers of cases and deaths due to COVID-19, there is a global effort to respond to this pandemic in terms of scale and speed. Different platforms are currently being used around the world for the development of best COVID-19 vaccine. While some COVID-19 vaccines have already been approved by different regulatory agencies, there is scarce data in large cohorts regarding the efficacy and security of COVID-19 vaccines in people with MS. In this short review we aimed the most important information to keep in mind regarding this topic.

Key Point 1: Immune response to SARS COV 2 and vaccine- (More information needed)

Key Point 2: Well-known vaccine responses from therapies used in MS. (We can presume that vaccination responses are blunted until naive B cells repopulate)

Key Point 3: COVID-19 vaccine mechanism of action and main candidates (Protective SARS-CoV-2 antibody titers were detected in 100% of untreated MS patients MS patient treated with ocrelizumab and fingolimod showed lowest rates of protective humoral immunity)

We have heard alot about pfizer but this study uses Sinopharm vaccine. This is an inactivated virus vaccine. Here are some details of alemtuzumab showing conversion (2-19months) and whilst pfizer and cladribine gives a winning combination (4/4) we see a failure with cladribine with Sinopharm (3/7) and it seems that if you are taking cladribine if you have an option select an RNA vaccine (pfizer) to get a better antibody response

Drulovic J, Ivanovic J, Martinovic V, Tamas O, Veselinovic N, Cujic D, Gnjatovic M, Mesaros S, Pekmezovic T. HUMORAL RESPONSE TO SARS-CoV-2 AND COVID-19 VACCINES IN PATIENTS WITH MULTIPLE SCLEROSIS TREATED WITH IMMUNE RECONSTITUTION THERAPIES. Mult Scler Relat Disord. 2021 Jul 15;54:103150. doi: 10.1016/j.msard.2021.103150.

Background: It has been generally accepted that people with MS (PwMS) should be vaccinated against COVID-19. The aim of our investigation was to evaluate the humoral response to natural SARS-CoV-2 infection and to two COVID-19 vaccines (BNT162b2 Pfizer-BioNTech and Beijing/Sinopharm BBIBP-CorV) in our cohort of PwMS under high efficacy disease modifying therapies (DMTs), cladribine and alemtuzumab.

Methods: Twenty two PwMS treated at the Clinic of Neurology, in Belgrade, who developed COVID-19 and/or were vaccinated against SARS-CoV-2, during treatment with cladribine and alemtuzumab, were included. Out of 18 patients treated with cladribine, 11 developed COVID-19, and 11 were vaccinated against SARS-CoV-2 (four with mRNA vaccine, 7 with Sinopharm). Four MS patients under alemtuzumab were vaccinated against SARS-CoV-2; three with mRNA, and one with Sinopharm vaccine. SARS-Cov-2 IgG response was measured using ELISA anti-spike protein-based serology (INEP, Belgrade, Serbia).

Results: All 7 patients under cladribine treatment who suffered from COVID-19, developed IgG antibodies, 2.0-5.5 months after last symptoms. All four (100%) patients under cladribine who were vaccinated with Pfizer-BioNTech vaccine, and three out of seven (42.9%) vaccinated with Sinopharm, developed antibodies. All 4 patients under alemtuzumab developed antibodies after vaccination. In all cases, seroprotection occurred, irrespective of timing of vaccination and absolute lymphocyte count.

Conclusion: Our findings in a small number of highly active PwMS in whom, lymphodepleting, immune reconstitution therapies, were applied in order to successfully manage MS, indicate that in a number of these patients it was possible to develop at the same time seroprotection in these patients after COVID-19 vaccination in these complex circumstances.

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  • Given the hypothesis that Long Covid is an ‘overeactive immune response affecting the brain ‘ (BBC Panorama) would it be informative to look at incidence/severity/duration of long Covid in immune compromised PwMS?

  • Thanks so much MD for continuing to supply us with all the data emerging about vaccine response in PwMS.
    Adding your droll, very British, sense of humour makes for an engaging read – as always!

    Not sure I’m taking as gospel the conclusions based on a mere four peeps who had Alemtuzumab, but it’s good to have the information.

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