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Al Rahbani GK, Woopen C, Dunsche M, Proschmann U, Ziemssen T, Akgün K. SARS-CoV-2-Specific Immune Cytokine Profiles to mRNA, Viral Vector and Protein-Based Vaccines in Patients with Multiple Sclerosis: Beyond Interferon Gamma. Vaccines (Basel) 2024; 12:684. [PMID: 38932415 PMCID: PMC11209537 DOI: 10.3390/vaccines12060684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Disease-modifying therapies (DMTs) impact the cellular immune response to severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) vaccines in patients with multiple sclerosis (pwMS). In this study, we aim to elucidate the characteristics of the involved antigen-specific T cells via the measurement of broad cytokine profiles in pwMS on various DMTs. We examined SARS-CoV-2-specific T cell responses in whole blood cultures characterized by the release of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-13, IL-17A, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α), as well as antibodies (AB) targeting the SARS-CoV-2 spike protein in pwMS following either two or three doses of mRNA or viral vector vaccines (VVV). For mRNA vaccination non-responders, the NVX-CoV2373 protein-based vaccine was administered, and immune responses were evaluated. Our findings indicate that immune responses to SARS-CoV-2 vaccines in pwMS are skewed towards a Th1 phenotype, characterized by IL-2 and IFN-γ. Additionally, a Th2 response characterized by IL-5, and to a lesser extent IL-4, IL-10, and IL-13, is observed. Therefore, the measurement of IL-2 and IL-5 levels could complement traditional IFN-γ assays to more comprehensively characterize the cellular responses to SARS-CoV-2 vaccines. Our results provide a comprehensive cytokine profile for pwMS receiving different DMTs and offer valuable insights for designing vaccination strategies in this patient population.
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Affiliation(s)
| | | | | | | | | | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, Technical University Dresden, 01307 Dresden, Germany; (G.K.A.R.); (C.W.); (M.D.); (U.P.); (T.Z.)
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2
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Yazdan Panah M, Vaheb S, Mokary Y, Afshari-Safavi A, Shaygannejad A, Ebrahimi N, Shaygannejad V, Mirmosayyeb O. Comparing the consequences of COVID-19 vaccination between central nervous system (CNS) demyelinating diseases and other neurological disorders. Vaccine 2024:S0264-410X(24)00702-3. [PMID: 38886142 DOI: 10.1016/j.vaccine.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/27/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Vaccination constitutes a crucial preventive measure against COVID-19 infection. Concerns have been raised regarding the efficacy of vaccines in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients due to various immunomodulatory medications and potential adverse events that may impact neurological function. This study aimed to explore the implications of COVID-19 vaccination within MS and NMSOD patients and compare it with other neurological disorders (OND). METHOD In this cross-sectional study conducted in Isfahan, Iran, baseline data and information on COVID-19 infections and vaccinations were collected from MS, NMOSD, and OND patients between September 2021 and September 2022. The predominant neurological disorders identified among OND patients encompassed headache, epilepsy, and Parkinson's disease. Logistic regression analysis was employed to compare COVID-19 vaccination outcomes among different patient groups, presenting odds ratios (OR) with 95% confidence intervals (CI). RESULTS The study included 1,307 participants, with 738 having MS, 96 having NMOSD, 76 having clinically isolated syndrome (CIS), and 397 having OND. Significantly higher odds of post-vaccination COVID-19 infection were detected in MS (OR = 3.86, p < 0.001) NMOSD (OR = 2.77, p = 0.015) patients than OND patients. The prior history of COVID-19 infection and the type of vaccine administered did not demonstrate significant associations with the likelihood of post-vaccination COVID-19 infection in MS and NMOSD patients (p > 0.05 for all). There were no significant differences in the rates of adverse events in MS, NMOSD, and OND patients, except the second dose, where NMOSD patients had lower odds than OND patients (OR = 0.55, p = 0.019). CONCLUSION Although the safety profile of COVID-19 vaccination in MS and NMOSD was similar to that in OND, the rates of post-vaccination COVID-19 infection in MS and NMOSD seem higher than OND. These findings highlight the importance of regular serological monitoring and the potential advantages of supplementary vaccine doses in MS and NMOSD patients.
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Affiliation(s)
- Mohammad Yazdan Panah
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Ebrahimi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Macdonald C, Palmateer N, McAuley A, Lindsay L, Hasan T, Hameed SS, Hall E, Jeffrey K, Grange Z, Gousias P, Mavin S, Jarvis L, Cameron JC, Daines L, Tibble H, Simpson CR, McCowan C, Katikireddi SV, Rudan I, Fagbamigbe AF, Ritchie L, Swallow B, Moss P, Robertson C, Sheikh A, Murray J. Association between antibody responses post-vaccination and severe COVID-19 outcomes in Scotland. NPJ Vaccines 2024; 9:107. [PMID: 38877008 PMCID: PMC11178861 DOI: 10.1038/s41541-024-00898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
Several population-level studies have described individual clinical risk factors associated with suboptimal antibody responses following COVID-19 vaccination, but none have examined multimorbidity. Others have shown that suboptimal post-vaccination responses offer reduced protection to subsequent SARS-CoV-2 infection; however, the level of protection from COVID-19 hospitalisation/death remains unconfirmed. We use national Scottish datasets to investigate the association between multimorbidity and testing antibody-negative, examining the correlation between antibody levels and subsequent COVID-19 hospitalisation/death among double-vaccinated individuals. We found that individuals with multimorbidity ( ≥ five conditions) were more likely to test antibody-negative post-vaccination and 13.37 [6.05-29.53] times more likely to be hospitalised/die from COVID-19 than individuals without conditions. We also show a dose-dependent association between post-vaccination antibody levels and COVID-19 hospitalisation or death, with those with undetectable antibody levels at a significantly higher risk (HR 9.21 [95% CI 4.63-18.29]) of these serious outcomes compared to those with high antibody levels.
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Affiliation(s)
- Calum Macdonald
- Usher Institute, University of Edinburgh, Teviot Pl, EH8 9AG, Edinburgh, UK.
- Health Data Research UK, Gibbs Building, 215 Euston Road, NW1 2BE, London, UK.
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens, Road, Glasgow, G4 0BA, UK.
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK.
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens, Road, Glasgow, G4 0BA, UK
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
| | - Laura Lindsay
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
| | - Taimoor Hasan
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
| | | | - Elliot Hall
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
| | - Karen Jeffrey
- Usher Institute, University of Edinburgh, Teviot Pl, EH8 9AG, Edinburgh, UK
| | - Zoë Grange
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
| | - Petros Gousias
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
| | - Sally Mavin
- Scottish Microbiology Reference Laboratory, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ, UK
| | - Lisa Jarvis
- Scottish National Blood Transfusion Service, Jack Copland Centre, 52 Research Avenue North, EH14 4BE, Edinburgh, UK
| | - J Claire Cameron
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Teviot Pl, EH8 9AG, Edinburgh, UK
| | - Holly Tibble
- Usher Institute, University of Edinburgh, Teviot Pl, EH8 9AG, Edinburgh, UK
| | - Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, PO Box 600, Wellington, 6140, Wellington, New Zealand
| | - Colin McCowan
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow Berkeley Square, 99 Berkeley St., G3 7HR, Glasgow, UK
| | - Igor Rudan
- Usher Institute, University of Edinburgh, Teviot Pl, EH8 9AG, Edinburgh, UK
| | - Adeniyi Francis Fagbamigbe
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill Rd, AB25 2ZD, Aberdeen, UK
| | - Lewis Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill Rd, AB25 2ZD, Aberdeen, UK
| | - Ben Swallow
- School of Mathematics and Statistics, University of St Andrews, KY16 9SS, St Andrews, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Cancer Sciences Building, Edgbaston, B15 2TT, Birmingham, UK
| | - Chris Robertson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Richmond Street Glasgow, G1 1XH, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Teviot Pl, EH8 9AG, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, Oxford, UK
| | - Josie Murray
- Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK
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Cree BAC, Maddux R, Bar‐Or A, Hartung H, Kaur A, Brown E, Li Y, Hu Y, Sheffield JK, Silva D, Harris S. SARS-CoV-2 vaccination and infection in ozanimod-treated participants with relapsing multiple sclerosis. Ann Clin Transl Neurol 2023; 10:1725-1737. [PMID: 37550942 PMCID: PMC10578897 DOI: 10.1002/acn3.51862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE To investigate the serologic response, predictors of response, and clinical outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and infection in ozanimod-treated participants with relapsing multiple sclerosis (RMS) from DAYBREAK. METHODS DAYBREAK (ClinicalTrials.gov-NCT02576717), an open-label extension study of oral ozanimod 0.92 mg, enrolled participants aged 18-55 years with RMS who completed phase 1-3 ozanimod trials. Participants who were fully vaccinated against SARS-CoV-2 with mRNA or non-mRNA vaccines, were unvaccinated, and/or had COVID-19-related adverse events (AEs, with or without vaccination) and postvaccination serum samples were included (n = 288). Spike receptor binding domain (RBD) antibody levels (seroconversion: ≥0.8 U/mL) and serologic evidence of SARS-CoV-2 infection (nucleocapsid IgG: ≥1 U/mL) were assessed (Roche Elecsys/Cobas e411 platform). RESULTS In fully vaccinated participants (n = 148), spike RBD antibody seroconversion occurred in 90% (n = 98/109) of those without serologic evidence of prior SARS-CoV-2 exposure (100% [n = 80/80] seroconversion after mRNA vaccination) and in 100% (n = 39/39) of participants with serologic evidence of viral exposure. mRNA vaccination predicted higher spike RBD antibody levels, whereas absolute lymphocyte count (ALC), age, body mass index, and sex did not. COVID-19-related AEs were reported in 10% (n = 15/148) of fully vaccinated participants-all were nonserious and not severe; all participants recovered. INTERPRETATION Most ozanimod-treated participants with RMS mounted a serologic response to SARS-CoV-2 vaccination and infection, regardless of participant characteristics or ALC levels. In this analysis, all COVID-19-related AEs post-full vaccination in participants taking ozanimod were nonserious and not severe.
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Affiliation(s)
- Bruce A. C. Cree
- Department of NeurologyWeill Institute for Neurosciences, University of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Amit Bar‐Or
- Department of Neurology, Center for Neuroinflammation, and Experimental Therapeutics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Hans‐Peter Hartung
- Department of NeurologyMedical Faculty, Heinrich‐Heine UniversityDüsseldorfGermany
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- Department of NeurologyMedical University of ViennaViennaAustria
- Palacký University OlomoucOlomoucCzech Republic
| | | | | | - Yicong Li
- Bristol Myers SquibbPrincetonNew JerseyUSA
| | - Yanhua Hu
- Bristol Myers SquibbPrincetonNew JerseyUSA
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5
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Kaufmann C, Morris M, Gombolay GY. Antibody response to SARS-CoV-2 vaccination or infection in a prospective cohort of children with neuroinflammatory diseases. Eur J Paediatr Neurol 2023; 46:30-34. [PMID: 37399703 PMCID: PMC10307668 DOI: 10.1016/j.ejpn.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Immune medications affect antibody responses to SARS-CoV-2 vaccination in adults with neuroinflammatory disorders, but little is known about antibody responses in children with neuroinflammation and on immune treatments. Here we measure antibody levels in response to SARS-CoV-2 vaccination in children receiving anti-CD20 monoclonal antibodies, or fingolimod. METHODS Children under 18 years of age with pediatric-onset neuroinflammatory disorders who received at least two mRNA vaccines were included. Plasma samples were assayed for SARS-CoV-2 antibodies (spike, spike receptor binding domain-RBD, nucleocapsid) and neutralization antibodies. RESULTS Seventeen participants with pediatric onset neuroinflammatory diseases were included: 12 multiple sclerosis, one neuromyelitis optica spectrum disorder, two MOG-associated disease, and two autoimmune encephalitis. Fourteen were on medications (11 on CD20 monoclonal antibodies-mAbs, one on fingolimod, one on steroids, one on intravenous immunoglobulin) and three were untreated. Nine patients also had pre-vaccination samples available. All participants had seropositivity to spike or spike RBD antibodies except for those receiving CD20 mAbs. However, this proportion was higher in children than in an adult MS patient cohort. The most significant contributor to antibody levels was duration of DMT. CONCLUSION SARS-CoV-2 antibodies are decreased in children on CD20 monoclonal antibodies than on other treatments. Treatment duration associated with vaccination responses.
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Affiliation(s)
| | - Morgan Morris
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, USA
| | - Grace Y Gombolay
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, USA; Children's Healthcare of Atlanta, Division of Neurology, Atlanta, GA, USA.
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6
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Gombolay G, Hallman-Cooper J. COVID-19 and the Pandemic-Related Aspects in Pediatric Demyelinating Disorders. Semin Pediatr Neurol 2023; 46:101055. [PMID: 37451752 PMCID: PMC10169322 DOI: 10.1016/j.spen.2023.101055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/05/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as Coronavirus-19 (COVID-19) infection, has been associated with several neurological symptoms, including acute demyelinating syndromes (ADS). There is a growing body of literature discussing COVID-19 and demyelinating conditions in adults; however, there is less published about COVID-19 demyelinating conditions in the pediatric population. This review aims to discuss the impact of COVID-19 in pediatric patients with central nervous system ADS (cADS) and chronic demyelinating conditions. We reviewed PubMed, Google Scholar, and Medline for articles published between December 1, 2019 and October 25, 2022 related to COVID-19 and pediatric demyelinating conditions. Of 56 articles reviewed, 20 cases of initial presentation of ADS associated with COVID-19 were described. The most commonly described cADS associated with COVID-19 infection in children was Acute Disseminated Encephalomyelitis followed by Transverse Myelitis. Cases of Myelin Oligodendrocyte Glycoprotein Antibody Disease, Neuromyelitis Optica Spectrum Disorder, and Multiple Sclerosis are also described. The risk of severe COVID-19 in pediatric patients with demyelinating conditions appears low, including in patients on disease modifying therapies, but studies are limited. The pandemic did affect disease modifying therapies in ADS, whether related to changes in prescriber practice or access to medications. COVID-19 is associated with ADS in children and the COVID-19 pandemic has impacted pediatric patients with demyelinating conditions in various ways.
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Affiliation(s)
- Grace Gombolay
- Department of Pediatrics, Division of Pediatric Neurology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
| | - Jamika Hallman-Cooper
- Department of Pediatrics, Division of Pediatric Neurology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
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7
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Bazylewicz M, Gudowska-Sawczuk M, Mroczko B, Kochanowicz J, Kułakowska A. COVID-19: The Course, Vaccination and Immune Response in People with Multiple Sclerosis: Systematic Review. Int J Mol Sci 2023; 24:9231. [PMID: 37298185 PMCID: PMC10253145 DOI: 10.3390/ijms24119231] [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: 04/17/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
When the Coronavirus Disease 2019 (COVID-19) appeared, it was unknown what impact it would have on the condition of patients with autoimmunological disorders. Attention was focused on the course of infection in patients suffering from multiple sclerosis (MS), specially treated with disease-modifying therapies (DMTs) or glucocorticoids. The impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the occurrence of MS relapses or pseudo-relapses was important. This review focuses on the risk, symptoms, course, and mortality of COVID-19 as well as immune response to vaccinations against COVID-19 in patients with MS (PwMS). We searched the PubMed database according to specific criteria. PwMS have the risk of infection, hospitalization, symptoms, and mortality due to COVID-19, mostly similar to the general population. The presence of comorbidities, male sex, a higher degree of disability, and older age increase the frequency and severity of the COVID-19 course in PwMS. For example, it was reported that anti-CD20 therapy is probably associated with an increased risk of severe COVID-19 outcomes. After SARS-CoV-2 infection or vaccination, MS patients acquire humoral and cellular immunity, but the degree of immune response depends on applied DMTs. Additional studies are necessary to corroborate these findings. However, indisputably, some PwMS need special attention within the context of COVID-19.
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Affiliation(s)
- Marcin Bazylewicz
- Department of Neurology, Medical University of Bialystok, M. Skłodowskiej-Curie 24A St., 15-276 Bialystok, Poland
| | - Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, M. Skłodowskiej-Curie 24A St., 15-276 Bialystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, M. Skłodowskiej-Curie 24A St., 15-276 Bialystok, Poland
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Tütüncü M, Demir S, Arslan G, Dinç Ö, Şen S, Gündüz T, Uzunköprü C, Gümüş H, Tütüncü M, Akçin R, Özakbaş S, Köseoğlu M, Bünül SD, Gezen O, Tezer DÇ, Baba C, Özen PA, Koç R, Elverdi T, Uygunoğlu U, Kürtüncü M, Beckmann Y, Doğan İG, Turan ÖF, Boz C, Terzi M, Tuncer A, Saip S, Karabudak R, Kocazeybek B, Efendi H, Bilge U, Siva A. mRNA versus inactivated virus COVID-19 vaccines in multiple sclerosis: Humoral responses and protectivity-Does it matter? Mult Scler Relat Disord 2023; 75:104761. [PMID: 37247488 DOI: 10.1016/j.msard.2023.104761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND COVID-19 vaccines are recommended for people with multiple sclerosis (pwMS). Adequate humoral responses are obtained in pwMS receiving disease-modifying therapies (DMTs) after vaccination, with the exception of those receiving B-cell-depleting therapies and non-selective S1P modulators. However, most of the reported studies on the immunity of COVID-19 vaccinations have included mRNA vaccines, and information on inactivated virus vaccine responses, long-term protectivity, and comparative studies with mRNA vaccines are very limited. Here, we aimed to investigate the association between humoral vaccine responses and COVID-19 infection outcomes following mRNA and inactivated virus vaccines in a large national cohort of pwMS receiving DMTs. METHODS This is a cross-sectional and prospective multicenter study on COVID-19-vaccinated pwMS. Blood samples of pwMS with or without DMTs and healthy controls were collected after two doses of inactivated virus (Sinovac) or mRNA (Pfizer-BioNTech) vaccines. PwMS were sub-grouped according to the mode of action of the DMTs that they were receiving. SARS-CoV-2 IgG titers were evaluated by chemiluminescent microparticle immunoassay. A representative sample of this study cohort was followed up for a year. COVID-19 infection status and clinical outcomes were compared between the mRNA and inactivated virus groups as well as among pwMS subgroups. RESULTS A total of 1484 pwMS (1387 treated, 97 untreated) and 185 healthy controls were included in the analyses (male/female: 544/1125). Of those, 852 (51.05%) received BioNTech, and 817 (48.95%) received Sinovac. mRNA and inactivated virus vaccines result in similar seropositivity; however, the BioNTech vaccination group had significantly higher antibody titers (7.175±10.074) compared with the Sinovac vaccination group (823±1.774) (p<0.001). PwMS under ocrelizumab, fingolimod, and cladribine treatments had lower humoral responses compared with the healthy controls in both vaccine types. After a mean of 327±16 days, 246/704 (34.9%) of pwMS who were contacted had COVID-19 infection, among whom 83% had asymptomatic or mild disease. There was no significant difference in infection rates of COVID-19 between participants vaccinated with BioNTech or Sinovac vaccines. Furthermore, regression analyses show that no association was found regarding age, sex, Expanded Disability Status Scale score (EDSS), the number of vaccination, DMT type, or humoral antibody responses with COVID-19 infection rate and disease severity, except BMI Body mass index (BMI). CONCLUSION mRNA and inactivated virus vaccines had similar seropositivity; however, mRNA vaccines appeared to be more effective in producing SARS-CoV-2 IgG antibodies. B-cell-depleting therapies fingolimod and cladribine were associated with attenuated antibody titer. mRNA and inactive virus vaccines had equal long-term protectivity against COVID-19 infection regardless of the antibody status.
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Affiliation(s)
- Melih Tütüncü
- Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Serkan Demir
- Neurology Department, Sancaktepe Şehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Gökhan Arslan
- Faculty of Medicine, Department of Physiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Öykü Dinç
- Faculty Of Pharmacy, Department Of Pharmaceutical Microbiology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Sedat Şen
- Faculty of Medicine, Department of Neurology, Ondokuz Mayıs University, Samsun, Turkey
| | - Tuncay Gündüz
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Cihat Uzunköprü
- Faculty of Medicine, Department of Neurology, Katip Celebi University, Izmir, Turkey
| | - Haluk Gümüş
- Faculty of Medicine, Department of Neurology, Selçuk University, Konya, Turkey
| | - Mesude Tütüncü
- Department of Neurology, Istanbul Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Rüveyda Akçin
- Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Serkan Özakbaş
- Faculty of Medicine, Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Mesrure Köseoğlu
- Department of Neurology, Istanbul Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Sena Destan Bünül
- Faculty of Medicine, Department of Neurology, Kocaeli University, İzmit/Kocaeli, Turkey
| | - Ozan Gezen
- Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Damla Çetinkaya Tezer
- Neurology Department, Sancaktepe Şehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Cavid Baba
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Turkey
| | - Pınar Acar Özen
- Faculty of Medicine, Department of Neurology, Haccettepe University, Ankara, Turkey
| | - Rabia Koç
- Faculty of Medicine, Department of Neurology, Uludag University, Bursa, Turkey
| | - Tuğrul Elverdi
- Cerrahpaşa Faculty of Medicine, Department of Hematology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Uğur Uygunoğlu
- Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Murat Kürtüncü
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Yeşim Beckmann
- Faculty of Medicine, Department of Neurology, Katip Celebi University, Izmir, Turkey
| | - İpek Güngör Doğan
- Neurology Department, Sancaktepe Şehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Ömer Faruk Turan
- Faculty of Medicine, Department of Neurology, Uludag University, Bursa, Turkey
| | - Cavit Boz
- Faculty of Medicine, Department of Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Murat Terzi
- Faculty of Medicine, Department of Neurology, Ondokuz Mayıs University, Samsun, Turkey
| | - Asli Tuncer
- Faculty of Medicine, Department of Neurology, Haccettepe University, Ankara, Turkey
| | - Sabahattin Saip
- Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Rana Karabudak
- Faculty of Medicine, Department of Neurology, Haccettepe University, Ankara, Turkey
| | - Bekir Kocazeybek
- Cerrahpaşa Faculty of Medicine, Department of Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Hüsnü Efendi
- Faculty of Medicine, Department of Neurology, Kocaeli University, İzmit/Kocaeli, Turkey
| | - Uğur Bilge
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
| | - Aksel Siva
- Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Faculty of Medicine, Department of Neurology, Uludag University, Bursa, Turkey
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9
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Holroyd KB, Conway SE. Central Nervous System Neuroimmunologic Complications of COVID-19. Semin Neurol 2023. [PMID: 37080234 DOI: 10.1055/s-0043-1767713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Autoimmune disorders of the central nervous system following COVID-19 infection include multiple sclerosis (MS), neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, autoimmune encephalitis, acute disseminated encephalomyelitis, and other less common neuroimmunologic disorders. In general, these disorders are rare and likely represent postinfectious phenomena rather than direct consequences of the SARS-CoV-2 virus itself. The impact of COVID-19 infection on patients with preexisting neuroinflammatory disorders depends on both the disorder and disease-modifying therapy use. Patients with MS do not have an increased risk for severe COVID-19, though patients on anti-CD20 therapies may have worse clinical outcomes and attenuated humoral response to vaccination. Data are limited for other neuroinflammatory disorders, but known risk factors such as older age and medical comorbidities likely play a role. Prophylaxis and treatment for COVID-19 should be considered in patients with preexisting neuroinflammatory disorders at high risk for developing severe COVID-19.
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Affiliation(s)
- Kathryn B Holroyd
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah E Conway
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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10
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Dumitrescu L, Papathanasiou A, Coclitu C, Garjani A, Evangelou N, Constantinescu CS, Popescu BO, Tanasescu R. An update on the use of sphingosine 1-phosphate receptor modulators for the treatment of relapsing multiple sclerosis. Expert Opin Pharmacother 2023; 24:495-509. [PMID: 36946625 PMCID: PMC10069376 DOI: 10.1080/14656566.2023.2178898] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated disorder of the CNS manifested by recurrent attacks of neurological symptoms (related to focal inflammation) and gradual disability accrual (related to progressive neurodegeneration and neuroinflammation). Sphingosine-1-phosphate-receptor (S1PR) modulators are a class of oral disease-modifying therapies (DMTs) for relapsing MS. The first S1PR modulator developed and approved for MS was fingolimod, followed by siponimod, ozanimod, and ponesimod. All are S1P analogues with different S1PR-subtype selectivity. They restrain the S1P-dependent lymphocyte egress from lymph nodes by binding the lymphocytic S1P-subtype-1-receptor. Depending on their pharmacodynamics and pharmacokinetics, they can also interfere with other biological functions. AREAS COVERED Our narrative review covers the PubMed English literature on S1PR modulators in MS until August 2022. We discuss their pharmacology, efficacy, safety profile, and risk management recommendations based on the results of phase II and III clinical trials. We briefly address their impact on the risk of infections and vaccines efficacy. EXPERT OPINION S1PR modulators decrease relapse rate and may modestly delay disease progression in people with relapsing MS. Aside their established benefit, their place and timing within the long-term DMT strategy in MS, as well as their immunological effects in the new and evolving context of the post-COVID-19 pandemic and vaccination campaigns warrant further study.
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Affiliation(s)
- Laura Dumitrescu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania
| | - Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - Catalina Coclitu
- Department of Multiple Sclerosis and Neuroimmunology, CHU Grenoble, Grenoble, France
| | - Afagh Garjani
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikos Evangelou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Cris S Constantinescu
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Neurology, Cooper Neurological Institute, Camden, NJ, USA
| | - Bogdan Ovidiu Popescu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania
| | - Radu Tanasescu
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
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11
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Pernicová E, Macounová P, Krsek M, Maďar R. Summary of Safety and Efficacy of COVID Vaccination in Patients with Multiple Sclerosis. Eur Neurol 2023; 86:263-276. [PMID: 36871554 PMCID: PMC10614228 DOI: 10.1159/000529982] [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: 07/26/2022] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic represents one of the most challenging issues that have recently influenced everyday life in countries all over the world. Understanding the risk of this disease is of high importance in patients with multiple sclerosis (MS) as they represent a vulnerable population through their treatment with disease-modifying therapies (DMTs). Infective episodes may trigger relapses and lead to deterioration of the health condition. SUMMARY Vaccination is an important preventive measure against infectious diseases. In MS patients, concerns have been raised about the effectiveness of vaccines in patients on various immunomodulatory drugs and about their possible adverse effects including impairment of neurological functions. The objectives of this article were to summarize the current knowledge on immune responses to the COVID-19 vaccines and their safety in MS patients and to provide practical guidance based on the data available to date. KEY MESSAGES Although MS is not associated with a higher risk of COVID-19, this infection can trigger relapses or pseudo-relapses. Vaccines against SARS-CoV-2 are recommended for all MS patients who are not in the active phase of the disease, despite the fact that there is still a lack of long-term reliable data on the effectiveness and safety of vaccines against COVID-19. Some DMTs can reduce vaccine humoral responses, but might still provide some protection and adequate T-cell response. To optimize the effectiveness of vaccination, the ideal timing of vaccine application and DMTs dosing regimen is crucial.
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Affiliation(s)
- Eva Pernicová
- Avenier, Centres of Vaccination and Travel Medicine, Brno and Ostrava, Czechia
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petra Macounová
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czechia,
| | - Martin Krsek
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Rastislav Maďar
- Avenier, Centres of Vaccination and Travel Medicine, Brno and Ostrava, Czechia
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
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12
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Kaido M, Kajiyama Y, Sasaki S, Saitou T, Esa Y, Watanabe Y, Fujimura H, Kobayashi J. [Antibody production capacity after COVID-19 vaccination in immune-mediated neuromuscular diseases under immunotherapy]. Rinsho Shinkeigaku 2023; 63:145-151. [PMID: 36843085 DOI: 10.5692/clinicalneurol.cn-001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The post-vaccination antibody response in patients with immune-mediated neuromuscular diseases under immuno-suppressive therapy has not been sufficiently verified. The Japanese Society of Neurology has stated that coronavirus disease 2019 (COVID-19) vaccination should be given priority in patients with immunotherapy-associated neuromuscular diseases; however, data on antibody production to a novel mRNA vaccine are scarce in these patients. In this study, we aimed to measure residual antibody titers after the second dose and produced antibodies after the third dose of SARS-CoV-2 mRNA vaccine in 25 patients with neuromuscular diseases under immuno-suppressive therapy (disease group). We compared the disease group antibody titers with those of 829 healthy employees in our hospital (control group). The disease group included 17 patients with myasthenia gravis, 4 with multiple sclerosis, 3 with inflammatory muscle disease, and 1 with chronic inflammatory demyelinating polyneuropathies. Seven cases of the disease group showed negative antibody levels (<15.0 s/co) before the third vaccination, and antibody titers in the positive cases ranged from 16.9 to 4,589.0 s/co. Three of the seven antibody-negative cases turned positive after the third vaccination, and all but one of the antibody-positive cases showed a booster effect, with antibody titers after the third dose ranging from 245.1 to 85,374.0 s/co (1.0 to 885.0 times higher than those before vaccination). Although the immune response in the disease group was modest compared to the control group, in which antibody titers after the third vaccination ranged from 67.8 to 150,000 s/co (0.9 to 5,402.1 times higher than those before vaccination), the result indicated that a constant immune response was achieved under immuno-suppressive therapy. Even in the control group, three participants tested negative for residual antibody before the third inoculation, and four of the antibody-positive participants (27.7-24,054.0 s/co) lacked a booster effect after the third vaccination.
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Affiliation(s)
- Misako Kaido
- Department of Clinical genetics, Sakai City Medical Center.,Department of Neurology, Sakai City Medical Center
| | - Yuta Kajiyama
- Department of Neurology, Sakai City Medical Center.,Department of Neurology, Osaka University Graduate School of Medicine
| | - Shinya Sasaki
- Department of Clinical Laboratory, Sakai City Medical Center
| | - Takako Saitou
- Department of Clinical Laboratory, Sakai City Medical Center
| | - Yoshiki Esa
- Department of Neurology, Sakai City Medical Center
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13
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Baker D, Forte E, Pryce G, Kang AS, James LK, Giovannoni G, Schmierer K. The impact of sphingosine-1-phosphate receptor modulators on COVID-19 and SARS-CoV-2 vaccination. Mult Scler Relat Disord 2023; 69:104425. [PMID: 36470168 PMCID: PMC9678390 DOI: 10.1016/j.msard.2022.104425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sphingosine-one phosphate receptor (S1PR) modulation inhibits S1PR1-mediated lymphocyte migration, lesion formation and positively-impacts on active multiple sclerosis (MS). These S1PR modulatory drugs have different: European Union use restrictions, pharmacokinetics, metabolic profiles and S1PR receptor affinities that may impact MS-management. Importantly, these confer useful properties in dealing with COVID-19, anti-viral drug responses and generating SARS-CoV-2 vaccine responses. OBJECTIVE To examine the biology and emerging data that potentially underpins immunity to the SARS-CoV-2 virus following natural infection and vaccination and determine how this impinges on the use of current sphingosine-one-phosphate modulators used in the treatment of MS. METHODS A literature review was performed, and data on infection, vaccination responses; S1PR distribution and functional activity was extracted from regulatory and academic information within the public domain. OBSERVATIONS Most COVID-19 related information relates to the use of fingolimod. This indicates that continuous S1PR1, S1PR3, S1PR4 and S1PR5 modulation is not associated with a worse prognosis following SARS-CoV-2 infection. Whilst fingolimod use is associated with blunted seroconversion and reduced peripheral T-cell vaccine responses, it appears that people on siponimod, ozanimod and ponesimod exhibit stronger vaccine-responses, which could be related notably to a limited impact on S1PR4 activity. Whilst it is thought that S1PR3 controls B cell function in addition to actions by S1PR1 and S1PR2, this may be species-related effect in rodents that is not yet substantiated in humans, as seen with bradycardia issues. Blunted antibody responses can be related to actions on B and T-cell subsets, germinal centre function and innate-immune biology. Although S1P1R-related functions are seeming central to control of MS and the generation of a fully functional vaccination response; the relative lack of influence on S1PR4-mediated actions on dendritic cells may increase the rate of vaccine-induced seroconversion with the newer generation of S1PR modulators and improve the risk-benefit balance IMPLICATIONS: Although fingolimod is a useful asset in controlling MS, recently-approved S1PR modulators may have beneficial biology related to pharmacokinetics, metabolism and more-restricted targeting that make it easier to generate infection-control and effective anti-viral responses to SARS-COV-2 and other pathogens. Further studies are warranted.
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Affiliation(s)
- David Baker
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
| | - Eugenia Forte
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Gareth Pryce
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Angray S Kang
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Centre for Oral Immunobiology and Regenerative Medicine, Dental Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Louisa K James
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Klaus Schmierer
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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14
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Weberpals J, Roumpanis S, Barer Y, Ehrlich S, Jessop N, Pedotti R, Vaknin-Dembinsky A, Brill L, Chodick G, Rouzic EML. Clinical outcomes of COVID-19 in patients with multiple sclerosis treated with ocrelizumab in the pre- and post-SARS-CoV-2 vaccination periods: Insights from Israel. Mult Scler Relat Disord 2022; 68:104153. [PMID: 36081277 PMCID: PMC9422340 DOI: 10.1016/j.msard.2022.104153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/08/2022] [Accepted: 08/28/2022] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused challenges in the management of patients living with multiple sclerosis (PLwMS). We investigated the occurrence and severity of COVID-19 infection post-vaccination among PLwMS treated with ocrelizumab and enrolled in the Maccabi Health Services (MHS) (n = 289) or followed at the Hadassah Medical Center (HMC) (n = 80) in Israel. Most patients were fully vaccinated (MHS n = 218; HMC n = 76) and confirmed infection post-vaccination was low (3.7% and 2.6%, respectively). MHS: infection was more severe (hospitalization/intensive care unit/death) in non-vaccinated (33.3%) vs vaccinated patients (25%). HMC: one vaccinated patient required hospitalization with COVID-19 vs two unvaccinated patients. These data from two Israel cohorts suggest that occurrence of COVID-19 after mRNA vaccination is low and limited in severity.
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Affiliation(s)
- Janick Weberpals
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Spyros Roumpanis
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Yael Barer
- Maccabitech, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, 27 Hamered, Tel Aviv 6812509, Israel
| | - Sharon Ehrlich
- Roche Pharmaceuticals Israel Ltd., 6 Hacharash st., Hod Hasharon 4524079, Israel
| | - Nikki Jessop
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Rosetta Pedotti
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, Basel 4070, Switzerland
| | - Adi Vaknin-Dembinsky
- Roche Pharmaceuticals Israel Ltd., 6 Hacharash st., Hod Hasharon 4524079, Israel
| | - Livnat Brill
- Department of Neurology and Laboratory of Neuroimmunology, The Agnes Ginges Center for Neurogenetics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, 27 Hamered, Tel Aviv 6812509, Israel
| | - Erwan Muros-Le Rouzic
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, Basel 4070, Switzerland,Corresponding author
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