#MSCOVID19 vaccine time again

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Whilst I realise there is COVID fatigue I post on this paper as it includies nearly 1000 people. Here there was reduction with fingolimod, ocrelizumab and rituximab, but at last more numbers with fingolimod and it is still a problem. I will be back again with something about MS that is not COVID to keep others happy.

Effect of different disease-modifying therapies on humoral response to BNT162b2 vaccine in Sardinian multiple sclerosis patientsMaristella Pitzalis, Maria Laura Idda, Valeria Lodde, Annalisa Loizedda, Monia Lobina, Magdalena Zoledzwieska, Francesca Virdis, Giuseppe Delogu, Federica Pirinu, Maria Giuseppina Marini, Maura Mingoia, Jessica Frau, Lorena Lorefice, Maria Fronza, Daniele Carmagini, Elisa Carta, Valeria Orrù, Sergio Uzzau, Paolo Solla, Federica Loi, Marcella Devoto, Maristella Steri, Edoardo Fiorillo, Matteo Floris, Ignazio Roberto Zarbo, Eleonora Cocco, Francesco CuccamedRxiv 2021.09.26.21264067; doi: https://doi.org/10.1101/2021.09.26.21264067

Objectives Vaccination against COVID-19 is highly recommended to patients affected by multiple sclerosis (MS); however, the impact of MS disease-modifying therapies (DMTs) on the immune response following vaccination has been only partially investigated. Here, we aimed to elucidate the effect of DMTs on the humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines in MS patients.

Methods We obtained sera from 912 Sardinian MS patients and 63 healthy controls 30 days after the second dose of BNT162b2 vaccine and tested them for SARS-CoV-2 response using anti-Spike (S) protein-based serology. Previous SARS-CoV-2 infection was assessed by anti-Nucleocapsid (N) serology. Patients were either untreated or undergoing treatment with a total of 13 different DMTs. Differences between treatment groups comprised of at least 10 patients were assessed by generalized linear mixed-effects model. Demographic and clinical data and smoking status were analyzed as additional factors potentially influencing humoral immunity from COVID-19 vaccine.

Results MS patients treated with natalizumab, teriflunomide, azathioprine, fingolimod, ocrelizumab, and rituximab showed significantly lower humoral responses compared to untreated patients. We did not observe a statistically significant difference in response between patients treated with the other drugs (dimethyl fumarate, interferon, alemtuzumab and glatiramer acetate) and untreated patients. In addition, older age, male, sex and active smoking were significantly associated with lower antibody titers against SARS-CoV-2. MS patients previously infected with SARS-CoV-2 had significantly higher humoral responses to vaccine than uninfected patients.

Conclusion Humoral response to BNT162b2 is significantly influenced by the specific DMTs followed by patients, as well as by other factors such as previous SARS-CoV-2 infection, age, sex, and smoking status. These results are important to inform targeted strategies to prevent clinically relevant COVID-19 in MS patients.

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MouseDoctor

22 comments

  • hello doc – good news no? would help cd20 anf FINGO treated?

    Merck (NYSE: MRK), known as MSD outside the United States and Canada, and Ridgeback Biotherapeutics today announced that molnupiravir (MK-4482, EIDD-2801), an investigational oral antiviral medicine, significantly reduced the risk of hospitalization or death at a planned interim analysis of the Phase 3 MOVe-OUT trial in at risk, non-hospitalized adult patients with mild-to-moderate COVID-19. At the interim analysis, molnupiravir reduced the risk of hospitalization or death by approximately 50%; 7.3% of patients who received molnupiravir were either hospitalized or died through Day 29 following randomization (28/385), compared with 14.1% of placebo-treated patients (53/377); p=0.0012. Through Day 29, no deaths were reported in patients who received molnupiravir, as compared to 8 deaths in patients who received placebo. At the recommendation of an independent Data Monitoring Committee and in consultation with the U.S. Food and Drug Administration (FDA), recruitment into the study is being stopped early due to these positive results. Merck plans to submit an application for Emergency Use Authorization (EUA) to the U.S. FDA as soon as possible based on these findings and plans to submit marketing applications to other regulatory bodies worldwide.

  • Whatever happened to the long acting antibodies in azd7442?

    That would solve the problem at least for the winter…

  • Why teriflunomide? Also what about the stars on the top? I would normally interpret them as significance, but there is none above the teriflunomide info. Just a mistake?

  • On an admittedly only partially related note, I do a search for “fingolimod COVID vaccine” periodically, and today I found that Google now returns a “featured snippet” at the top of the search results quoting the very first Israeli study that came out, “For MS patients treated with fingolimod, we currently do not promote COVID-19 vaccination unless their lymphocyte count is above 1000 cells/mm3.” So at least for me, searching for “fingolimod COVID vaccine” returns advice that people on fingolimod should not be vaccinated, which not actually the official advice of any that I know of.

    That bothered me quite a bit. (Not least because I actually did end up making an antibody response to my third Moderna shot.) I provided “feedback” but who knows if that actually accomplishes anything.

  • Can anyone clarify?
    There is talk of a booster. As well as talk of a 3rd dose for people on anti CD20 et al
    Are they one and the same?
    I read that the NHS have instructed hospitals and GPs to write to patients who should be receiving this (those) and that they should receive them by 14 Oct.

    Has anyone been called for it? Have any of your HCP heard anything about it

    • No they are not the same people with immunosupprression can have a third dose and then presumably a booster some time in the future
      The booster is for the over 50s and helath care workers etc. I think that there is no clarity search “Green book and chaper 14a”. Is they any one under 50 that have recieved text letter about signing up

      • Confusing here in US too. My recent neuro visit told me per CDC current guidelines, I should wait 3 months from Ocrevus infusion to get my over 50 booster. (We know I had no antibody response because I enrolled in medical study to be tested) Still Per CDC, antibodies levels in vaccinated people, including the immune compromised, should not be checked! Seems there is good reason to test immune compromised. Nevertheless, Nurse monitoring my infusion told me other Pwms at my clinic were going to their internists and insisting on their antibody levels being tested. (Of course this means it’s not covered by health insurance so it’s only accessible to those with money to spare and determination.) So is it better to get a booster or a 3rd shot if I had no response to vaccine? Unclear to me. Again, many taking it into their own hands here, and just getting in line for a third. Is it unclear messaging or unclear fluid situation? What to do???

        • I should wait 3 montsh from ocrevus over 50 booster….So why this advice and where is the evidence that this is good advice. The VELOCE (Ocrevus vaccine studies) study did vaccines at 12 weeks which is 3 months…so this where they seem to be coming from. At 3 months could you make a response sure you can but the chances of this occuring is less than if there is a longer break.

          Not checking response…in the un immunocompromised you expect a 100% response to why test…I guess the question is what does the antibody response mean, but I wanted to know. I suspect if I had no response I would remain cautious.

          The third shot comes at a shorter time interval I think from 4 weeks from the second…I suspect the chances of producing some response is higher as it would put you nearer the 5 month mark.

          I believe we are giving people the option of a delay, I guess we will see what happens but data from the cancer/arthrtis field has not been great news

  • Not sure about the authors’ conclusions regarding NTZ humoral response to the vaccine compared to healthy controls. They stated there was significantly lower humoral response but unless I’m reading the graph incorrectly it looks similar to DMF and HC. Since NTZ is not a B cell depleter I would assume a fairly normal an response to the vaccine.

    • I would have agreed with you as there are an increasing number of studies showing that most people with natalizmab respond to vaccine. However, if you look at the plots in our paper in MedRXiv Tallantyre et al. There were more people in the middle range so they maybe there is something in a reduction. However maybe their were more people in our study on astrazeneca.

  • Do you feel people treated with teriflunomide, dimethyl fumarate and the like are comparable to older immunocompetent people (65+) as regards probable waning vaccine efficacy?
    I ask because I’m (on teriflunomide) offered a 3rd shot now, only 3 months after my last one. I feel this is probably too soon. I do feel that a boostershot, after 6 months, is probably a good idea.
    Would you agree on this?

      • evidently – that’s what my question is about: I think that with teriflunomide, I would benefit more from a booster (after e.g. 6 months, like 65+ in my country), than from a third shot (after 2 or 3 months). I wanted to know if you agree.

          • thank you – so you agree I should choose the booster over the third shot (I will probably get the choice in my country)

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