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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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Etemadifar M, Abhari AP, Nouri H, Eighani N, Salari M, Sedaghat N. Effect of multiple sclerosis disease-modifying therapies on the real-world effectiveness of two doses of BBIBP-CorV (Sinopharm) vaccine. J Neurol Sci 2023; 444:120518. [PMID: 36521195 PMCID: PMC9731817 DOI: 10.1016/j.jns.2022.120518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Immunogenicity data shows blunted responses to COVID-19 vaccination among people with MS (pwMS) on certain disease-modifying therapies (DMTs). Still, it is uncertain how this data translates into the clinic. OBJECTIVE To assess the effect of DMTs and other factors on the effectiveness of inactivated vaccination in pwMS. METHODS This cohort study was conducted in a period in which Iran experienced two COVID-19 peaks caused by the Delta variant. We used multivariable cox regression to compare COVID-19-free survivals, and an ordinal logistic model to compare COVID-19 severity between vaccinated pwMS on different DMTs. RESULTS A total of 617 pwMS were included in the final analysis, with a mean [SD] follow-up of 25.59 weeks [5.48] after their second dose. Laboratory/imaging-confirmed breakthrough COVID-19 occurred in 15/277 (5.41%) of injectable-treated (reference), 10/61 (16.39%) of fingolimod-treated (adjusted hazard ratio (aHR) [95% confidence interval (CI)]: 2.80 [1.24, 6.29]; P = 0.01), 9/128 (7.03%) of other oral-treated (aHR [95%CI]: 1.16 [0.50, 2.68]; P = 0.73), 19/145 (13.10%) of anti-CD20-treated (aHR [95%CI]: 2.11 [1.05, 4.22]; P = 0.04), and 6/56 (10.71%) of non-treated pwMS (aHR [95%CI]: 1.52 [0.57, 4.04]; P = 0.40). Age (adjusted Odds Ratio [aOR] [95%CI]: 1.05 [1.00, 1.10], P = 0.05) number of comorbidities (aOR [95%CI]: 2.05 [1.06, 3.96], P = 0.03), fingolimod therapy (aOR [95%CI]: 10.39 [2.47, 43.62], P < 0.01), and anti-CD20 therapy (aOR [95%CI]: 4.44 [1.49, 13.23], P < 0.01) were independently associated with a more severe COVID-19 course. CONCLUSION The observed results stress the importance of developing personalized vaccination schedules and reservation of COVID-19 treatment resources for older pwMS with comorbidities receiving fingolimod or anti-CD20 therapies.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Parsa Abhari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection Malignancy and Autoimmunity (NIIMA), Universal Scientific, Education, and Research Network (USERN), Isfahan, Iran
| | - Hosein Nouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection Malignancy and Autoimmunity (NIIMA), Universal Scientific, Education, and Research Network (USERN), Isfahan, Iran
| | - Naghme Eighani
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahad Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection Malignancy and Autoimmunity (NIIMA), Universal Scientific, Education, and Research Network (USERN), Isfahan, Iran.
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Freeman L, Longbrake EE, Coyle PK, Hendin B, Vollmer T. High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing-Remitting Multiple Sclerosis. CNS Drugs 2022; 36:1285-1299. [PMID: 36350491 PMCID: PMC9645316 DOI: 10.1007/s40263-022-00965-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
There are > 18 distinct disease-modifying therapy (DMT) options covering 10 mechanisms of action currently approved by the US Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). Given the multitude of available treatment options, and recent international consensus guidelines offering differing recommendations, there is broad heterogeneity in how the DMTs are used in clinical practice. Choosing a DMT for newly diagnosed patients with MS is currently a topic of significant debate in MS care. Historically, an escalation approach to DMT was used for newly diagnosed patients with RRMS. However, the evidence for clinical benefits of early treatment with high-efficacy therapies (HETs) in this population is emerging. In this review, we provide an overview of the DMT options and MS treatment strategies, and discuss the clinical benefits of HETs (including ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine) in the early stages of MS, along with safety concerns associated with these DMTs. By minimizing the accumulation of neurological damage early in the disease course, early treatment with HETs may enhance long-term clinical outcomes over the lifetime of the patient.
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Affiliation(s)
- Léorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St, Austin, TX, 78701, USA.
| | | | - Patricia K Coyle
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Barry Hendin
- Banner, University Medicine Neurosciences Clinic, Phoenix, AZ, USA
| | - Timothy Vollmer
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Hosseini SSJ, Dudakova A, Kummer K, Zschüntzsch J. [SARS-CoV-2 antibody response to the second COVID-19 vaccination in neuromuscular disease patients under immune modulating treatment]. DER NERVENARZT 2022; 93:1219-1227. [PMID: 35997783 PMCID: PMC9395911 DOI: 10.1007/s00115-022-01363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 12/04/2022]
Abstract
Successful vaccination (adequate elevation of anti-spike protein antibodies) is attributed with sufficient protection against a severe course of coronavirus disease 2019 (COVID-19). For patients with chronic inflammatory diseases (CID) and immunosuppression the success of vaccination is an ongoing scientific discourse. Therefore, we evaluated the antibody titer against the S1 antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 2 weeks after complete immunization in patients with an underlying neuromuscular disease (NMD), who presented to our neurological day clinic and outpatient department for regular infusions of immunoglobulins. The data show that patients with chronic autoimmune NMD and simultaneous immunosuppressive or immune modulating treatment show an antibody response after vaccination with both mRNA and vector vaccines. In comparison to healthy subjects there is a comparable number of seroconversions due to the vaccination. A correlation between immunoglobulin dose and vaccination response could not be found; however, in contrast, there was a significant reduction of specific antibody synthesis, especially for the combination of mycophenolate mofetil (MMF) and prednisolone.
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Affiliation(s)
- S S Justus Hosseini
- Neuromuskuläres Zentrum Göttingen, Klinik für Neurologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Anna Dudakova
- Institut für Medizinische Mikrobiologie und Virologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Karsten Kummer
- Neuromuskuläres Zentrum Göttingen, Klinik für Neurologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Jana Zschüntzsch
- Neuromuskuläres Zentrum Göttingen, Klinik für Neurologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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5
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Kister I, Curtin R, Pei J, Perdomo K, Bacon TE, Voloshyna I, Kim J, Tardio E, Velmurugu Y, Nyovanie S, Valeria Calderon A, Dibba F, Stanzin I, Samanovic MI, Raut P, Raposo C, Priest J, Cabatingan M, Winger RC, Mulligan MJ, Patskovsky Y, Silverman GJ, Krogsgaard M. Hybrid and vaccine-induced immunity against SAR-CoV-2 in MS patients on different disease-modifying therapies. Ann Clin Transl Neurol 2022; 9:1643-1659. [PMID: 36165097 PMCID: PMC9538694 DOI: 10.1002/acn3.51664] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To compare "hybrid immunity" (prior COVID-19 infection plus vaccination) and post-vaccination immunity to SARS CoV-2 in MS patients on different disease-modifying therapies (DMTs) and to assess the impact of vaccine product and race/ethnicity on post-vaccination immune responses. METHODS Consecutive MS patients from NYU MS Care Center (New York, NY), aged 18-60, who completed primary COVID-19 vaccination series ≥6 weeks previously were evaluated for SARS CoV-2-specific antibody responses with electro-chemiluminescence and multiepitope bead-based immunoassays and, in a subset, live virus immunofluorescence-based microneutralization assay. SARS CoV-2-specific cellular responses were assessed with cellular stimulation TruCulture IFNγ and IL-2 assay and, in a subset, with IFNγ and IL-2 ELISpot assays. Multivariate analyses examined associations between immunologic responses and prior COVID-19 infection while controlling for age, sex, DMT at vaccination, time-to-vaccine, and vaccine product. RESULTS Between 6/01/2021 and 11/11/2021, 370 MS patients were recruited (mean age 40.6 years; 76% female; 53% non-White; 22% with prior infection; common DMT classes: ocrelizumab 40%; natalizumab 15%, sphingosine-1-phosphate receptor modulators 13%; and no DMT 8%). Vaccine-to-collection time was 18.7 (±7.7) weeks and 95% of patients received mRNA vaccines. In multivariate analyses, patients with laboratory-confirmed prior COVID-19 infection had significantly increased antibody and cellular post-vaccination responses compared to those without prior infection. Vaccine product and DMT class were independent predictors of antibody and cellular responses, while race/ethnicity was not. INTERPRETATION Prior COVID-19 infection is associated with enhanced antibody and cellular post-vaccine responses independent of DMT class and vaccine type. There were no differences in immune responses across race/ethnic groups.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center, Department of NeurologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Ryan Curtin
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Jinglan Pei
- Genentech, Inc.South San FranciscoCaliforniaUSA
| | - Katherine Perdomo
- NYU Multiple Sclerosis Comprehensive Care Center, Department of NeurologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Tamar E. Bacon
- NYU Multiple Sclerosis Comprehensive Care Center, Department of NeurologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Iryna Voloshyna
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Joseph Kim
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Ethan Tardio
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Yogambigai Velmurugu
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Samantha Nyovanie
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Andrea Valeria Calderon
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Fatoumatta Dibba
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Igda Stanzin
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Marie I. Samanovic
- NYU Langone Vaccine Center, Department of MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Pranil Raut
- Genentech, Inc.South San FranciscoCaliforniaUSA
| | | | | | | | | | - Mark J. Mulligan
- NYU Langone Vaccine Center, Department of MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Yury Patskovsky
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Gregg J. Silverman
- Division of Rheumatology, Department of MedicineNew York University Grossman School of MedicineNew YorkNew York10016USA
| | - Michelle Krogsgaard
- Laura and Isaac Perlmutter Cancer Center and Department of PathologyNew York University Grossman School of MedicineNew YorkNew York10016USA
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Ito Y, Honda A, Kurokawa M. COVID-19 mRNA Vaccine in Patients With Lymphoid Malignancy or Anti-CD20 Antibody Therapy: A Systematic Review and Meta-Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e691-e707. [PMID: 35459624 PMCID: PMC8958822 DOI: 10.1016/j.clml.2022.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 04/09/2023]
Abstract
BACKGROUND The humoral response to vaccination in individuals with lymphoid malignancies or those undergoing anti-CD20 antibody therapy is impaired, but details of the response to mRNA vaccines to protect against COVID-19 remain unclear. This systematic review and meta-analysis aimed to characterize the response to COVID-19 mRNA vaccines in patients with lymphoid malignancies or those undergoing anti-CD20 antibody therapy. MATERIALS AND METHODS A literature search retrieved 52 relevant articles, and random-effect models were used to analyze humoral and cellular responses. RESULTS Lymphoid malignancies and anti-CD20 antibody therapy for non-malignancies were significantly associated with lower seropositivity rates (risk ratio 0.60 [95% CI 0.53-0.69]; risk ratio 0.45 [95% CI 0.39-0.52], respectively). Some subtypes (chronic lymphocytic leukemia, treatment-naïve chronic lymphocytic leukemia, myeloma, and non-Hodgkin's lymphoma) exhibited impaired humoral response. Anti-CD20 antibody therapy within 6 months of vaccination decreased humoral response; moreover, therapy > 12 months before vaccination still impaired the humoral response. However, anti-CD20 antibody therapy in non-malignant patients did not attenuate T cell responses. CONCLUSION These data suggest that patients with lymphoid malignancies or those undergoing anti-CD20 antibody therapy experience an impaired humoral response, but cellular response can be detected independent of anti-CD20 antibody therapy. Studies with long-term follow-up of vaccine effectiveness are warranted (PROSPERO registration number: CRD42021265780).
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Affiliation(s)
- Yusuke Ito
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Akira Honda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan
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7
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Berlit P. Update zu: Neurologische Manifestationen bei COVID-19. DGNEUROLOGIE 2022. [PMCID: PMC9004217 DOI: 10.1007/s42451-022-00429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Berlit
- Deutsche Gesellschaft für Neurologie (DGN), Berlin, Deutschland
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8
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Gratch D, Zhovtis Ryerson L. Stable multiple sclerosis patients on anti-CD20 therapy should go on extended interval dosing-Commentary. Mult Scler 2022; 28:695-696. [PMID: 35365058 DOI: 10.1177/13524585211067708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Smith TE, Madhavan M, Gratch D, Patel A, Saha V, Sammarco C, Rimler Z, Zuniga G, Gragui D, Charvet L, Cutter G, Krupp L, Kister I, Ryerson LZ. Risk of COVID-19 infection and severe disease in MS patients on different disease-modifying therapies. Mult Scler Relat Disord 2022; 60:103735. [PMID: 35398713 PMCID: PMC8915504 DOI: 10.1016/j.msard.2022.103735] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/26/2022] [Accepted: 03/10/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The risk of SARS-CoV-2 infection and severity with disease modifying therapies (DMTs) in multiple sclerosis (MS) remains unclear, with some studies demonstrating increased risks of infection with B-cell-depleting (anti-CD20) therapies and severity, while others fail to observe an association. Most existing studies are limited by a reliance on 'numerator' data (i.e., COVID-19 cases) only. OBJECTIVE To assess the risks of COVID-19 by DMT, this study aimed to assess both 'numerator' (patients with SARS-CoV-2 infection) and 'denominator' data (all patients treated with DMTs of interest) to determine if any DMTs impart an increased risk of SARS-CoV-2 infection or disease severity. METHODS We systematically reviewed charts and queried patients during clinic encounters in the NYU MS Comprehensive Care Center (MSCCC) for evidence of COVID-19 in all patients who were on the most commonly used DMTs in our clinic (sphingosine-1-phosphate receptor (S1P) modulators (fingolimod/siponimod), rituximab, ocrelizumab, fumarates (dimethyl fumarate/diroximel fumarate), and natalizumab). COVID-19 status was determined by clinical symptoms (CDC case definition) and laboratory testing where available (SARS-CoV-2 PCR, SARS-CoV-2 IgG). Multivariable analyses were conducted to determine predictors of infection and severe disease (hospitalization or death) using SARS-CoV-2 infected individuals per DMT group and all individuals on a given DMT as denominator. RESULTS We identified 1,439 MS patients on DMTs of interest, of which 230 had lab-confirmed (n = 173; 75.2%) or suspected (n = 57; 24.8%) COVID-19. Infection was most frequent in those on rituximab (35/138; 25.4%), followed by fumarates (39/217; 18.0%), S1P modulators (43/250; 17.2%), natalizumab (36/245; 14.7%), and ocrelizumab (77/589; 13.1%). There were 14 hospitalizations and 2 deaths. No DMT was found to be significantly associated with increased risk of SARS-CoV-2 infection. Rituximab was a predictor of severe SARS-CoV-2 infection among patients with SARS-CoV-2 infection (OR 6.7; 95% CI 1.1-41.7) but did not reach statistical significance when the entire patient population on DMT was used (OR 2.8; 95% CI 0.6-12.2). No other DMT was associated with an increased risk of severe COVID-19. CONCLUSIONS Analysis of COVID-19 risk among all patients on the commonly used DMTs did not demonstrate increased risk of infection with any DMT. Rituximab was associated with increased risk for severe disease.
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Affiliation(s)
- Tyler E Smith
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016.
| | - Maya Madhavan
- NYU Langone Health Department of Neurology, 222 E 41(st) St, 9(th) Floor, New York City, New York, 10017
| | - Daniel Gratch
- NYU Langone Health Department of Neurology, 222 E 41(st) St, 9(th) Floor, New York City, New York, 10017
| | - Aneek Patel
- NYU Langone Health Department of Neurology, 222 E 41(st) St, 9(th) Floor, New York City, New York, 10017
| | - Valerie Saha
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Carrie Sammarco
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Zoe Rimler
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Guadalupe Zuniga
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Dunia Gragui
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Leigh Charvet
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Gary Cutter
- University of Alabama School of Public Health Department of Biostatistics, 403B Ryals Public Health Building, 1665 University Boulevard, Birmingham AL, 35294
| | - Lauren Krupp
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Ilya Kister
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
| | - Lana Zhovtis Ryerson
- NYU Langone Multiple Sclerosis Care Center, 240 E 38(th) St, 13(th) Floor, New York City, New York, 10016
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10
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Peluso MJ, Donatelli J, Henrich TJ. Long-term immunologic effects of SARS-CoV-2 infection: leveraging translational research methodology to address emerging questions. Transl Res 2022; 241:1-12. [PMID: 34780969 PMCID: PMC8588584 DOI: 10.1016/j.trsl.2021.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/01/2022]
Abstract
The current era of COVID-19 is characterized by emerging variants of concern, waning vaccine- and natural infection-induced immunity, debate over the timing and necessity of vaccine boosting, and the emergence of post-acute sequelae of SARS-CoV-2 infection. As a result, there is an ongoing need for research to promote understanding of the immunology of both natural infection and prevention, especially as SARS-CoV-2 immunology is a rapidly changing field, with new questions arising as the pandemic continues to grow in complexity. The next phase of COVID-19 immunology research will need focus on clearer characterization of the immune processes defining acute illness, development of a better understanding of the immunologic processes driving protracted symptoms and prolonged recovery (ie, post-acute sequelae of SARS-CoV-2 infection), and a growing focus on the impact of therapeutic and prophylactic interventions on the long-term consequences of SARS-CoV-2 infection. In this review, we address what is known about the long-term immune consequences of SARS-CoV-2 infection and propose how experience studying the translational immunology of other infections might inform the approach to some of the key questions that remain.
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Affiliation(s)
- Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California
| | - Joanna Donatelli
- Division Experimental Medicine, University of California, San Francisco, California
| | - Timothy J Henrich
- Division Experimental Medicine, University of California, San Francisco, California.
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11
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Bajwa HM, Novak F, Nilsson AC, Nielsen C, Holm DK, Østergaard K, Witt AH, Byg KE, Johansen IS, Mittl K, Rowles W, Zamvil SS, Bove R, Sabatino JJ, Sejbaek T. Persistently reduced humoral and sustained cellular immune response from first to third SARS-CoV-2 mRNA vaccination in anti-CD20-treated multiple sclerosis patients. Mult Scler Relat Disord 2022; 60:103729. [PMID: 35334278 PMCID: PMC8898195 DOI: 10.1016/j.msard.2022.103729] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 01/14/2023]
Abstract
Objective To examine humoral and cellular response in multiple sclerosis patients on anti-CD20 therapy after third BNT162b2 mRNA SARS-CoV-2 vaccination. Methods A prospective longitudinal study design from first throughout third vaccination in Danish and American MS centers. All participants were treated with ocrelizumab. Antibody (Ab) levels were assessed before and after third vaccination using SARS-CoV-2 IgG II Quant assay (Abbott Laboratories). B- and T-lymphocytes enumeration was done with BD Multitest™6-color TBNK reagent. Spike-specific T-cell responses were measured through PBMC stimulation with spike peptide pools (JPT Peptide Technologies). Results We found that 14.0%, 37.7%, and 33.3% were seropositive after first, second and third vaccination. The median Ab-levels were 74.2 BAU/mL (range: 8.5–2427) after second vaccination, as well as 43.7 BAU/ml (range: 7.8–366.1) and 31.3 BAU/mL (range: 7.9–507.0) before and after third vaccination, respectively. No difference was found in levels after second and third vaccination (p = 0.1475). Seropositivity dropped to 25.0% of participants before the third vaccination, a relative reduction of 33.3% (p = 0.0020). No difference was found between frequencies of spike reactive CD4+and CD8+ T-cells after second (0.65 ± 0.08% and 0.95 ± 0.20%, respectively) and third vaccination (0.99 ± 0.22% and 1.3 ± 0.34%, respectively). Conclusion In this longitudinal cohort we found no significant increased humoral or cellular response with administration of a third SARS-CoV-2 mRNA vaccination. These findings suggest the need for clinical strategies to include allowance of B cell reconstitution before repeat vaccination and/or provision of pre-exposure prophylactic monoclonal antibodies.
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12
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Galati A, McElrath T, Bove R. Use of B-Cell–Depleting Therapy in Women of Childbearing Potential With Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder. Neurol Clin Pract 2022; 12:154-163. [PMID: 35733945 PMCID: PMC9208398 DOI: 10.1212/cpj.0000000000001147] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
Purpose of Review There is considerable heterogeneity in the use of B-cell depletion in women of childbearing age, likely driven at least in part by the discrepancy between the product labels and what is known about the physiology of IgG1, including breastmilk and placental transfer. Recent Findings We provide practical considerations on the use of this medication class in women of childbearing potential. We discuss prepregnancy planning including vaccinations, safety of B-cell depletion during pregnancy, and postpartum considerations including breastfeeding. Summary B-cell–depleting monoclonal antibodies have shown to be effective for prepregnancy and postpartum prevention of inflammatory activity in MS and neuromyelitis optica spectrum disorder. B-cell–depleting therapies are large IgG1 monoclonal antibodies, which have minimal transfer across the placenta and into breastmilk. Consideration of risks and benefits of these therapies should be considered in counseling women planning pregnancy and postpartum.
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Affiliation(s)
- Alexandra Galati
- Division of Neuroimmunology and Glial Biology (A.G., R.B.), Department of Neurology, University of California, San Francisco, UCSF Weill Institute for the Neurosciences, San Francisco, CA; and Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas McElrath
- Division of Neuroimmunology and Glial Biology (A.G., R.B.), Department of Neurology, University of California, San Francisco, UCSF Weill Institute for the Neurosciences, San Francisco, CA; and Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Riley Bove
- Division of Neuroimmunology and Glial Biology (A.G., R.B.), Department of Neurology, University of California, San Francisco, UCSF Weill Institute for the Neurosciences, San Francisco, CA; and Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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13
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Gyang TV, Evans JP, Miller JS, Alcorn K, Peng J, Bell EH, Zeng C, Gumina R, Liu SL, Segal BM. Neutralizing antibody responses against SARS-CoV-2 in vaccinated people with multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173221087357. [PMID: 35342640 PMCID: PMC8941285 DOI: 10.1177/20552173221087357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Background Patients with multiple sclerosis (pwMS) are often treated with disease
modifying therapies (DMT) with immunomodulatory effects. This is of
particular concern following the development of several vaccines to combat
coronavirus disease 19 (COVD-19), a potentially fatal illness caused by
SARS-CoV-2. Objectives To determine the efficacy of SARS-CoV-2 vaccination in pwMS and the impact of
disease modifying therapies (DMT) on vaccine response. Methods This is a prospective longitudinal study in pwMS. Longitudinal serum samples
were obtained prior to, and after SARS-CoV-2 mRNA vaccination. A novel
neutralizing antibody (nAb) assay was used to determine nAbs titres against
SARS-CoV-2 spike. Results We observed that (1) pwMS on B-cell depleting therapies exhibited reduced
response to vaccination compared to other pwMS, correlating with time from
last anti-CD20 infusion, (2) prior COVID-19 illness, DMT category, and
pyramidal function were significant predictors of vaccine responsiveness,
and (3) circulating absolute lymphocyte count (ALC) and IgG levels
correlated with nAb levels. Conclusions We demonstrate that pwMS exhibit reduced nAb response to mRNA vaccination
dependent on DMT status and identify predictive biomarkers for vaccine
efficacy. We conclude that additional vaccination strategies may be
necessary to achieve protective immunity in pwMS.
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Affiliation(s)
- Tirisham V Gyang
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA
| | - John P Evans
- Center for Retrovirus Research, The Ohio State University, Columbus, OH 43210, USA
| | - Joseph S Miller
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | - Kariss Alcorn
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Juan Peng
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Erica H Bell
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA
| | - Cong Zeng
- Center for Retrovirus Research, The Ohio State University, Columbus, OH 43210, USA
| | - Richard Gumina
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Shan-Lu Liu
- Center for Retrovirus Research, The Ohio State University, Columbus, OH 43210, USA
| | - Benjamin M Segal
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA
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14
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Ghadiri F, Sahraian MA, Azimi A, Moghadasi AN. The study of COVID-19 infection following vaccination in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103363. [PMID: 35158433 PMCID: PMC8559439 DOI: 10.1016/j.msard.2021.103363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/31/2022]
Abstract
Background At this time vaccination against SARS-CoV2 is a global priority. Cases with multiple sclerosis (MS) were among the first vaccinated populations in Iran. We evaluated the change in the frequency of COVID-19 after vaccination and the associated factors with severe COVID-19 infection before and after full vaccination. Methods A questionnaire was validated to investigate the basic characteristics (age, gender, education, body mass index, smoking status, and comorbidities), MS disease and treatment status (MS type, MS duration, The Expanded Disability Status Scale (EDSS), disease modifying treatments) and the information about COVID-19 infection and severity. Results 692 (91.9%) of participants have received both doses of vaccines, of which Sinopharm appeared to be the most common type. Significant difference of COVID-19 infection prevalence was seen before vaccination and after full vaccination (difference: 0.16, 95% CI: 0.12–0.20) (p value < 0.001). The difference was not significant for severe cases (those who were admitted in the ward or ICU) relative to the COVID-19 cases or the whole participants. Of all the basic and disease factors, only EDSS showed a significant association with severe COVID-19 before vaccination. Severe COVID-19 in fully vaccinated cases did not show any significant relation to any of basic or disease characteristics except with prior history of severe allergic reactions (OR: 17.1, p value: 0.001). Discussion The decreased frequency of infection with SARS-CoV2 was predictable but the insignificant difference in cases with the severe forms of the disease raise concern. The only significant predictor was found to be severe allergic reactions. As there are debates on antiCD20 s association with severe COVID-19 and vaccine efficacy, we could not find such significant relation. The other noticeable point about the found relation of EDSS and critical COVID-19 before vaccination is the absence of such relation after full vaccination.
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Affiliation(s)
- Fereshteh Ghadiri
- Sina MS research Center, Sina Hospital, Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Hasan Abad Sq., Tehran, Iran
| | - Mohammad Ali Sahraian
- Sina MS research Center, Sina Hospital, Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Hasan Abad Sq., Tehran, Iran
| | - Amirreza Azimi
- Sina MS research Center, Sina Hospital, Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Hasan Abad Sq., Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Sina MS research Center, Sina Hospital, Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Hasan Abad Sq., Tehran, Iran.
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15
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Etemadifar M, Sedaghat N, Nouri H, Lotfi N, Chitsaz A, Khorvash R, Zolfaghari H, Ghasemi Movaghar A, Pourabbas M, Salari M. SARS-CoV-2 serology among people with multiple sclerosis on disease-modifying therapies after BBIBP-CorV (Sinopharm) inactivated virus vaccination: Same story, different vaccine. Mult Scler Relat Disord 2022; 57:103417. [PMID: 34875487 PMCID: PMC8607735 DOI: 10.1016/j.msard.2021.103417] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Various studies indicated blunted humoral responses to COVID-19 mRNA and viral vector vaccines among people with multiple sclerosis (pwMS) on sphingosine 1-phosphate receptor (S1PR) modulators and anti-CD20 therapies (aCD20); however, limited evidence was found regarding SARS-CoV-2 serology after inactivated virus vaccination. OBJECTIVE To provide evidence regarding humoral response to COVID-19 inactivated virus vaccination among pwMS on disease-modifying therapies (DMTs). METHODS A cohort study was carried out in Isfahan, Iran, enrolling DMT-exposed pwMS and unexposed (UX) healthy participants. Post-vaccination anti-SARS-CoV-2 Spike IgG serology testing was carried out among the participants and compared between participants based on their DMT exposure, using proper statistical tests. A multivariable logistic regression model was used to control for confounding. Association between the second vaccine dose-to-phlebotomy (vac2phleb) and the humoral response was investigated in each DMT-exposed cohort, using linear regression. Among the aCD20 cohort, the association of the last aCD20 infusion-to-first vaccine dose period with serostatus was investigated using an unpaired t-test. RESULTS After enrolling 358 participants (144 pwMS and 214 healthy), blunted humoral responses were only observed in fingolimod (Log10 mean diff. [SE]: 0.72 [0.18], P = 0.001) and aCD20 (Log10 mean diff. [SE]: 0.75 [0.15], P < 0.001) cohorts compared to the UX cohort. Multivariable analysis confirmed the results. The study did not achieve enough statistical power to detect a significant association between the vac2phleb period and humoral responses. The last aCD20 infusion to first vaccination dose period was longer in the seroconverted pwMS on aCD20 (mean diff. [SE]: 8.43 weeks [2.57], P = 0.005). CONCLUSION The results of this study mirrored the results of previous studies among mRNA- or viral vector-vaccinated pwMS on DMTs. Therefore, it can be concluded that mode of action contributes less than timing, to the efficiency of vaccination strategies among pwMS on DMTs - especially the ones on S1PR modulators and aCD20. Meanwhile, the mentioned pwMS should be advised to receive early boosters and remain vigilant until further data becomes available and more efficient vaccination strategies are crafted.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahad Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran.
| | - Hosein Nouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - Noushin Lotfi
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Chitsaz
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Khorvash
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Zolfaghari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ghasemi Movaghar
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Pourabbas
- Biotechnology Research Center, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
| | - Mehri Salari
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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