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Moisset X, Leray E, Chenaf C, Taithe F, Vukusic S, Mulliez A, Clavelou P. Risk of Relapse After COVID-19 Vaccination Among Patients With Multiple Sclerosis in France: A Self-Controlled Case Series. Neurology 2024; 103:e209662. [PMID: 39141880 DOI: 10.1212/wnl.0000000000209662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES People with multiple sclerosis (MS) have an increased risk of severe coronavirus infection due to their level of motor disability or exposure to certain immunosuppressive treatments. Thus, patients with MS have had priority access to coronavirus disease 2019 (COVID-19) vaccination. However, relapses after vaccination have been reported, leading some patients to not seek the recommended booster doses. The main objective was to estimate the risk of severe relapse after 1, 2, and 3 (booster) doses of COVID-19 vaccination in patients with MS. The secondary objectives were to assess the risk of relapse in clinically meaningful subgroups according to the type of vaccine, the characteristics of the patients, and the use of disease-modifying treatments (DMTs). METHODS We conducted a nationwide study using data from the French National Health Data System. Patients with MS were identified according to ICD codes, specific treatments, and reimbursement data up to March 31, 2022. Relapses requiring treatment with high-dose corticosteroids were identified. A self-controlled case series method was used to evaluate the risk of relapse associated with COVID-19 vaccines in the 45 days after vaccination. The associated risk was evaluated after 1, 2, or 3 (booster) doses and is expressed as overall incidence rate ratios (IRRs) and in subgroups of interest. RESULTS Overall, 124,545 patients with MS were identified on January 1, 2021, and 82% received at least 1 dose of a COVID-19 vaccine (n = 102,524) until December 31, 2021, for a total of 259,880 doses. The combined IRR for MS relapse was 0.97 (0.91-1.03, p = 0.30). The same absence of risk was confirmed in various subgroups (age younger than 50 years, duration of MS < 10 years, use of DMT). A small increase in the relapse risk cannot be excluded after a booster dose (IRR 1.39 [1.08-1.80]) for patients with high MS activity, especially when not treated. DISCUSSION There is no increased risk of relapse requiring corticosteroid therapy after COVID-19 vaccination for almost all patients. We cannot exclude an increased risk after the booster dose for patients who have had at least 2 relapses in the previous 2 years. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that COVID-19 vaccination does not increase the risk of severe relapse in patients with MS.
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Affiliation(s)
- Xavier Moisset
- From the Université Clermont Auvergne (X.M., C.C., P.C.), CHU Clermont-Ferrand, Inserm, Neuro-Dol; Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309; Service de Neurologie (F.T.), CHU Clermont-Ferrand; Service de Neurologie (S.V.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Sclé; and Biostatistics Unit (A.M.), DRCI, CHU Clermont-Ferrand, France
| | - Emmanuelle Leray
- From the Université Clermont Auvergne (X.M., C.C., P.C.), CHU Clermont-Ferrand, Inserm, Neuro-Dol; Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309; Service de Neurologie (F.T.), CHU Clermont-Ferrand; Service de Neurologie (S.V.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Sclé; and Biostatistics Unit (A.M.), DRCI, CHU Clermont-Ferrand, France
| | - Chouki Chenaf
- From the Université Clermont Auvergne (X.M., C.C., P.C.), CHU Clermont-Ferrand, Inserm, Neuro-Dol; Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309; Service de Neurologie (F.T.), CHU Clermont-Ferrand; Service de Neurologie (S.V.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Sclé; and Biostatistics Unit (A.M.), DRCI, CHU Clermont-Ferrand, France
| | - Frederic Taithe
- From the Université Clermont Auvergne (X.M., C.C., P.C.), CHU Clermont-Ferrand, Inserm, Neuro-Dol; Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309; Service de Neurologie (F.T.), CHU Clermont-Ferrand; Service de Neurologie (S.V.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Sclé; and Biostatistics Unit (A.M.), DRCI, CHU Clermont-Ferrand, France
| | - Sandra Vukusic
- From the Université Clermont Auvergne (X.M., C.C., P.C.), CHU Clermont-Ferrand, Inserm, Neuro-Dol; Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309; Service de Neurologie (F.T.), CHU Clermont-Ferrand; Service de Neurologie (S.V.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Sclé; and Biostatistics Unit (A.M.), DRCI, CHU Clermont-Ferrand, France
| | - Aurelien Mulliez
- From the Université Clermont Auvergne (X.M., C.C., P.C.), CHU Clermont-Ferrand, Inserm, Neuro-Dol; Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309; Service de Neurologie (F.T.), CHU Clermont-Ferrand; Service de Neurologie (S.V.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Sclé; and Biostatistics Unit (A.M.), DRCI, CHU Clermont-Ferrand, France
| | - Pierre Clavelou
- From the Université Clermont Auvergne (X.M., C.C., P.C.), CHU Clermont-Ferrand, Inserm, Neuro-Dol; Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309; Service de Neurologie (F.T.), CHU Clermont-Ferrand; Service de Neurologie (S.V.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Sclé; and Biostatistics Unit (A.M.), DRCI, CHU Clermont-Ferrand, France
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Carvajal R, Zabalza A, Carbonell-Mirabent P, Martínez-Gómez X, Esperalba J, Pappolla A, Rando A, Cobo-Calvo A, Tur C, Rodriguez M, Río J, Comabella M, Castilló J, Rodrigo-Pendás JÁ, Braga N, Mongay-Ochoa N, Guío-Sánchez C, Vidal-Jordana Á, Arrambide G, Rodríguez-Acevedo B, Midaglia L, Borras-Bermejo B, Galán I, Sastre-Garriga J, Montalban X, Otero-Romero S, Tintoré M. Vaccine Safety and Immunogenicity in Patients With Multiple Sclerosis Treated With Natalizumab. JAMA Netw Open 2024; 7:e246345. [PMID: 38607624 PMCID: PMC11015356 DOI: 10.1001/jamanetworkopen.2024.6345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/13/2024] [Indexed: 04/13/2024] Open
Abstract
Importance Vaccination in patients with highly active multiple sclerosis (MS) requiring prompt treatment initiation may result in impaired vaccine responses and/or treatment delay. Objective To assess the immunogenicity and safety of inactivated vaccines administered during natalizumab treatment. Design, Setting, and Participants This self-controlled, prospective cohort study followed adult patients with MS from 1 study center in Spain from September 2016 to February 2022. Eligible participants included adults with MS who completed immunization for hepatitis B virus (HBV), hepatitis A virus (HAV), and COVID-19 during natalizumab therapy. Data analysis was conducted from November 2022 to February 2023. Exposures Patients were categorized according to their time receiving natalizumab treatment at the time of vaccine administration as short-term (≤1 year) or long-term (>1 year). Main Outcomes and Measures Demographic, clinical, and radiological characteristics were collected during the year before vaccination (prevaccination period) and the year after vaccination (postvaccination period). Seroprotection rates and postvaccination immunoglobulin G titers were determined for each vaccine within both periods. Additionally, differences in annualized relapse rate (ARR), new T2 lesions (NT2L), Expanded Disability Status Scale (EDSS) scores, and John Cunningham virus (JCV) serostatus between the 2 periods were assessed. Results Sixty patients with MS (mean [SD] age, 43.2 [9.4] years; 44 female [73.3%]; 16 male [26.7%]; mean [SD] disease duration, 17.0 [8.7] years) completed HBV, HAV, and mRNA COVID-19 immunization during natalizumab treatment, with 12 patients in the short-term group and 48 patients in the long-term group. The global seroprotection rate was 93% (95% CI, 86%-98%), with individual vaccine rates of 92% for HAV (95% CI, 73%-99%), 93% for HBV (95% CI, 76%-99%), and 100% for the COVID-19 messenger RNA vaccine (95% CI, 84%-100%). Between the prevaccination and postvaccination periods there was a significant reduction in the mean (SD) ARR (0.28 [0.66] vs 0.01 [0.12]; P = .004) and median (IQR) NT2L (5.00 [2.00-10.00] vs 0.81 [0.00-0.50]; P = .01). No changes in disability accumulation were detected (median [IQR] EDSS score 3.5 [2.0-6.0] vs 3.5 [2.0-6.0]; P = .62). No differences in safety and immunogenicity were observed for all vaccines concerning the duration of natalizumab treatment. Conclusions and Relevance The findings of this cohort study suggest that immunization with inactivated vaccines during natalizumab therapy was both safe and immunogenic, regardless of the treatment duration. Natalizumab may be a valuable option for proper immunization, averting treatment delays in patients with highly active MS; however, this strategy needs to be formally evaluated.
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Affiliation(s)
- René Carvajal
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Martínez-Gómez
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juliana Esperalba
- Department of Microbiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Pappolla
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ariadna Rando
- Department of Microbiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Cobo-Calvo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodriguez
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Ángel Rodrigo-Pendás
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nathane Braga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Guío-Sánchez
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Blanca Borras-Bermejo
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya (UVic-UCC)
| | - Susana Otero-Romero
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya (UVic-UCC)
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Tanaka K, Demchuk AM, Malo S, Hill MD, Holodinsky JK. Risk of stroke within 3, 7, 14, 21 and 30 days after influenza vaccination in Alberta, Canada: A population-based study. Eur J Neurol 2024; 31:e16172. [PMID: 38117538 PMCID: PMC11236019 DOI: 10.1111/ene.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND PURPOSE Influenza vaccination is associated with a longer-term protective effect against stroke; however, it has a short-term inflammatory response which may increase short-term risk of stroke. The aim was to investigate the association between influenza vaccination and short-term risk of stroke in adults. METHODS Administrative data were obtained from the Alberta Health Care Insurance Plan for all adults in Alberta, Canada, from September 2009 to December 2018. The hazard of any stroke (acute ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage and transient ischaemic attack) within 3, 7, 14, 21 and 30 days of influenza vaccination compared to unexposed time was analysed using Andersen-Gill Cox models, with adjustment for age, sex, anticoagulant use, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, hypertension, income quintile, and rural or urban home location. RESULTS In the entire cohort consisting of 4,141,209 adults (29,687,899 person-years), 1,769,565 (42.7%) individuals received at least one vaccination. In total 38,126 stroke events were recorded with 1309 occurring within 30 days of a vaccination event. Influenza vaccination was associated with a significantly reduced hazard of stroke within 3 days (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.73-0.93), 7 days (HR 0.87, 95% CI 0.80-0.95), 14 days (HR 0.87, 95% CI 0.81-0.93), 21 days (HR 0.85, 95% CI 0.80-0.91) and 30 days (HR 0.66, 95% CI 0.65-0.68). CONCLUSIONS An increased early risk associated with vaccination was not observed. The risk of stroke was reduced at all time points within 30 days after influenza vaccination.
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Affiliation(s)
- Koji Tanaka
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Andrew M. Demchuk
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Department of Radiology, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Shaun Malo
- Analytics and Performance Reporting BranchAlberta HealthEdmontonCanada
| | - Michael D. Hill
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Department of Radiology, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Jessalyn K. Holodinsky
- Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Department of Emergency Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- Centre for Health Informatics, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
- O'Brien Institute for Public Health, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
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