Long time, no COVID posts but today we have
Achiron A et al. Ther Adv Neurol Disord. 2021 14:17562864211012835. doi: 10.1177/17562864211012835.
Groups is Israel were first to report on the effects of two doses of COVID-19 vaccine. They showed that CD20 depleting antibodies and fingolimod inhibited the antibody response. This led to the suggestion by some that it may not be worth vaccinating people with MS. However, this view was questioned and this was rather supported when they looked at T cell responses as the vaccined made T cell responses.
Achiron A. Humoral immune response in multiple sclerosis patients following PfizerBNT162b2 COVID19 vaccination: Up to 6 months cross-sectional study. J Neuroimmunol. 2021;361:577746. doi: 10.1016/j.jneuroim.2021.577746
It was also seen that there was a T cell response with ocrelizumab, but not with fingolimod. So why is it suggested that that CD20-depleting antibodies may increase symptomatic disease (possibly invloving hospitalization), whereas this is not the case with fingolimod. Because as fingolimod was blocking T and B cell responses this should lead to worse outcomes, but it doesn’t.
So Interesting question. I dont have the answer.
However, maybe they simply did not look hard enough to see if fingolimod was worsening outcomes after COVID-19 infection. In the study showing worse outcomes after infection in vaccinated people treated with fingolimod and ocrelizumab they looked at information from 19,000 people (see below). To see worsening there has to be enough events of worsening if you look at 19,000 people and the risk is say 1% you see 190 people with infection if you look at 190 people you may see 1 or 2, which is too low to make a call. If we look at the numbers of people in the studies before this study they contained about 2500 people and they contain more people taking ocrelizumab than fingolimod so it will be easier to see a problem with ocrelizumab than fingolimod. It was shown that the antibody response wanes so there was a need for a booster.
This group were not the first to report what happened after the third dose? There was a greater response but data was not reported for ocrelizumab and fingolimod as they apparently were not deemed “vaccination-safe”.
So it is interesting that vaccination is coming into the MS drug vocabulary and the question is whether this will influence choice of treatments? Moving forward what do you think?
At the moment we get annual flu vaccines maybe COVID top-ups will influence your choice of treatment.
COVID-19 vaccination in patients with multiple sclerosis: Safety and humoral efficacy of the third booster dose.Dreyer-Alster S, Menascu S, Mandel M, Shirbint E, Magalashvili D, Dolev M, Flechter S, Givon U, Guber D, Stern Y, Miron S, Polliack M, Falb R, Sonis P, Gurevich M, Achiron A.J Neurol Sci. 2022 Jan 21;434:120155.Background: As immunity against SARS-COV-2 wanes following first and second doses of vaccination, a third dose is administered in several countries around the world. Similarly to the first doses, risks related to vaccination and humoral immune response in patients with multiple sclerosis (MS) need to be assessed.
Objective: Characterize safety and humoral immune response following the third dose of COVID-19 vaccination in a large cohort of MS patients.
Methods: We assessed the safety of the third dose of the BNT162b2-COVID-19 mRNA vaccination in adult MS patients and evaluated SARS-CoV-2 IgG response.
Results: Two hundred and eleven adult MS patients received a third dose of BNT162b2 COVID-19 vaccination. Median follow up time was 66 days from vaccine administration (IQR 54-84). The frequency of any adverse event was 54.5%, with the most common reported adverse events being fatigue, local pain at the injection site, fever and muscle or joint pain. Transient increase in MS symptoms was reported in 3.8% of patients, none of them requiring treatment. The rate of acute relapses treated with IV steroids was 3.3%. In a sub-group of 55 patients, 20 untreated and 35 treated with vaccination-safe disease-modifying treatments, SARS-CoV-2 IgG levels increased 21-fold (median ± SD 21.6 ± 53.05).
Conclusions: The third dose of COVID-19-BNT162b2 vaccine proved safe for MS patients, with no increased risk of relapse activity. Untreated patients and patients treated with vaccination-safe disease-modifying treatments show significant increase in SARS-CoV-2 IgG levels following the third dose of vaccination.