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.