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Serhan M, Psihogios A, Kabir N, Bota AB, Mithani SS, Smith DP, Zhu DT, Greyson D, Wilson S, Fell D, Top KA, Bettinger JA, Wilson K. A scoping review of active, participant centred, digital adverse events following immunization (AEFI) surveillance of WHO approved COVID-19 vaccines: A Canadian immunization Research Network study. Hum Vaccin Immunother 2024; 20:2293550. [PMID: 38374618 PMCID: PMC10880498 DOI: 10.1080/21645515.2023.2293550] [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: 07/21/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024] Open
Abstract
This scoping review examines the role of digital solutions in active, participant-centered surveillance of adverse events following initial release of COVID-19 vaccines. The goals of this paper were to examine the existing literature surrounding digital solutions and technology used for active, participant centered, AEFI surveillance of novel COVID-19 vaccines approved by WHO. This paper also aimed to identify gaps in literature surrounding digital, active, participant centered AEFI surveillance systems and to identify and describe the core components of active, participant centered, digital surveillance systems being used for post-market AEFI surveillance of WHO approved COVID-19 vaccines, with a focus on the digital solutions and technology being used, the type of AEFI detected, and the populations under surveillance. The findings highlight the need for customized surveillance systems based on local contexts and the lessons learned to improve future vaccine monitoring and pandemic preparedness.
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Affiliation(s)
- Mohamed Serhan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Athanasios Psihogios
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nooh Kabir
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - A. Brianne Bota
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Salima S. Mithani
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - David P. Smith
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - David T. Zhu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sarah Wilson
- Health Protection, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Populations & Public Health Research Program, ICES, Toronto, ON, Canada
| | - Deshayne Fell
- Department of Pediatrics, Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Karina A. Top
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Departments of Pediatrics and Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
- O’Neill Institute for National and Global Health Law, Georgetown University
- Bruyère Research Institute, Ottawa, Canada
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Ganelin‐Cohen E, Buxbaum C, Bosak N, Sobol S, Vaknin‐Dembinsky A, Hellmann MA, Wilf‐Yarkoni A, Regev K, Pustovoyt E, Shifrin A, Wexler Y, Rozenberg A. The effect of COVID-19 vaccination on multiple sclerosis activity as reflected by MRI. Brain Behav 2024; 14:e3587. [PMID: 38940313 PMCID: PMC11212002 DOI: 10.1002/brb3.3587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/23/2023] [Accepted: 05/04/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Examining the safety of theBNT162b2 mRNA vaccine in multiple sclerosis (MS) patients remains inconclusive, particularly regarding the potential for disease exacerbations. This study aims to assess the effects of BNT162b2 COVID-19 vaccination on disease activity in MS patients through sequential MRI imaging. METHODS A retrospective study of 84 MS patients from five Israeli hospitals was conducted. MS lesion load was determined from three brain MRI scans, one postvaccination and two prevaccination scans. A post hoc analysis compared subgroups featuring vaccinated and unvaccinated patients respectively, with early onset MS. RESULTS The cohort included 70 women with early onset (mean age 16.4 ± 0.8 years) and adult onset (mean age 34.9 ± 1.1 years) MS. Among the early onset group, vaccinated patients showed an increased risk of new lesions (p = .00026), while there was no increased risk among adult-onset patients. Additionally, a comparison between early onset vaccinated and nonvaccinated groups revealed a higher risk of increased lesions in the vaccinated group (p = .024). DISCUSSION Overall, the study suggests that the BNT162b2 vaccine is generally safe in MS patients, with no association found between vaccination and new lesions in most patients. However, close MRI follow-up is recommended for early-onset MS cases to monitor lesion development.
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Affiliation(s)
- Esther Ganelin‐Cohen
- Neuroimmunological ClinicInstitute of Pediatric Neurology, Schneider Children's Medical Center of IsraelPetah TikvaIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Chen Buxbaum
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Noam Bosak
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Shani Sobol
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Adi Vaknin‐Dembinsky
- Unit for Neuro‐Immunology, Multiple Sclerosis & Cell Therapy, Department of NeurologyHadassah Medical CenterJerusalemIsrael
| | - Mark A Hellmann
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Neurology, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
| | - Adi Wilf‐Yarkoni
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Neurology, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
| | - Keren Regev
- The Neuroimmunology and Multiple Sclerosis Unit, Neurology InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Elizaveta Pustovoyt
- The Neuroimmunology and Multiple Sclerosis Unit, Neurology InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Alla Shifrin
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Yair Wexler
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life SciencesTel‐Aviv UniversityTel AvivIsrael
| | - Ayal Rozenberg
- Department of NeurologyRambam Health Care CampusHaifaIsrael
- Neuroimmunology Laboratory, Department of Neurology, Rambam Health Care Campus and Ruth and Bruce Rapaport Faculty of Medicine, TechnionIsrael Institute of TechnologyHaifaIsrael
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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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Burian K, Heidler F, Frahm N, Hecker M, Langhorst SE, Mashhadiakbar P, Streckenbach B, Baldt J, Meißner J, Richter J, Zettl UK. Vaccination status and self-reported side effects after SARS-CoV-2 vaccination in relation to psychological and clinical variables in patients with multiple sclerosis. Sci Rep 2024; 14:12248. [PMID: 38806524 PMCID: PMC11133397 DOI: 10.1038/s41598-024-62541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
The recent SARS-CoV-2 pandemic and the vaccination campaign posed a challenge to patients with autoimmune disease, such as multiple sclerosis (MS). We aimed for investigating whether psychological/sociodemographic/clinical characteristics of MS patients are associated with SARS-CoV-2 vaccination status and self-reported vaccination side effects (SEs). We have asked patients with MS about their willingness to receive recommended standard vaccinations pre-pandemically since June 2019. Between 10/2021 and 01/2022, we surveyed 193 of these MS patients about their current SARS-CoV-2 vaccination status, their perception of vaccination-related SEs, and reasons for and against SARS-CoV-2 vaccination. 75.6% of the patients declared their willingness to receive standard vaccinations before the pandemic. 84.5%, 78.2%, and 13.0% of the patients had received the first, second, and third SARS-CoV-2 vaccination, respectively, until the follow-up survey. The most common reason for not getting vaccinated against SARS-CoV-2 was concern about possible side effects (82.1%), followed by the belief that the vaccines had not been adequately tested (64.3%). Vaccination-related SEs were reported by 52.8% of the patients. Younger age, higher education, lower degree of disability, relapsing disease course, shorter disease duration, not receiving a disease-modifying therapy and higher anxiety and depression levels were associated with the occurrence of certain vaccination-related SEs. Concerns about novel vaccines are widespread among MS patients and necessitate targeted education of the patients, especially to those with more severe psychopathological symptoms (anxiety or depression) and those who are generally skeptical of vaccination.
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Affiliation(s)
- Katja Burian
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany.
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany.
| | - Felicita Heidler
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Janina Meißner
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Jörg Richter
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
- Faculty of Health Sciences, University of Hull, Cottingham Rd, Hull, HU6 7RX, UK
- Durham Law School, The Palatine Centre, Durham University, Stockton Rd, Durham, DH1 3LE, UK
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
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Krett JD, Salter A, Newsome SD. Era of COVID-19 in Multiple Sclerosis Care. Neurol Clin 2024; 42:319-340. [PMID: 37980121 PMCID: PMC10288315 DOI: 10.1016/j.ncl.2023.06.006] [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] [Indexed: 11/20/2023]
Abstract
The unprecedented scope of the coronavirus disease 2019 (COVID-19) pandemic resulted in numerous disruptions to daily life, including for people with multiple sclerosis (PwMS). This article reviews how disruptions in multiple sclerosis (MS) care prompted innovations in delivery of care (eg, via telemedicine) and mobilized the global MS community to rapidly adopt safe and effective practices. We discuss how our understanding of the risks of COVID-19 in PwMS has evolved along with recommendations pertaining to disease-modifying therapies and vaccines. With lessons learned during the COVID-19 pandemic, we examine potential questions for future research in this new era of MS care.
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Affiliation(s)
- Jonathan D Krett
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
| | - Amber Salter
- Section on Statistical Planning & Analysis, Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Scott D Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA.
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6
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Marantos T, Kyriazopoulou E, Lekakis V, Voumvourakis KI, Tsiodras S. Immunogenicity and safety of vaccines in multiple sclerosis: A systematic review and meta-analysis. J Neurol Sci 2024; 456:122852. [PMID: 38142541 DOI: 10.1016/j.jns.2023.122852] [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: 10/12/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Seroconversion rate of vaccines varies and requires further elucidation in patients with multiple sclerosis (MS) under treatment with disease-modifying therapies (DMTs). We aimed to investigate this in a systematic review and meta-analysis. METHODS MEDLINE(PubMed) and Cochrane databases were searched based on a pre-specified protocol (PROSPERO: CRD42020202018). Studies reporting on patients with MS, diagnosed with McDonald criteria getting vaccinated with any type of vaccine were included in the analysis. The primary endpoint was the incidence of patients being seropositive and experience adverse events after vaccination. Outcomes were expressed as proportions with respective 95% confidence interval (CI). Two reviewers independently screened and reviewed existing literature and assessed study quality with the Methodological index for non-randomized studies. RESULTS Of 295 articles, 45 studies were analyzed. Seroconversion after COVID-19 vaccines was 76% (95% CI, 70-80; I2 = 95%; 20 studies including 5601 patients. Protection was lower in patients treated with anti-CD20 antibodies and sphingosine-1-phosphate receptor (S1PR) modulators compared to untreated patients or treatment with other DMTs. Relapse occurred in 2% (95% CI, 1-3; I2 = 86%; 16 studies including 7235 patients). Seroconversion after seasonal influenza vaccines was 82% (95% CI, 65-91; I2 = 90%; 6 studies including 490 patients). Relapse rate was similar to this after COVID-19 vaccination. CONCLUSION The majority of MS patients vaccinated for COVID-19 or seasonal influenza mount an adequate immune response without safety concerns. Data on other vaccines are limited.
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Affiliation(s)
- Theodoros Marantos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Evdoxia Kyriazopoulou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Vasileios Lekakis
- Department of Gastroenterology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Sotirios Tsiodras
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
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7
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Di Filippo M, Ferraro D, Ragonese P, Prosperini L, Maniscalco GT, Gallo A, Cavalla P, Lorefice L, Nociti V, Di Sabatino E, Clerico M, Guaschino C, Radaelli M, Fantozzi R, Buttari F, Laroni A, Gajofatto A, Calabrese M, Malucchi S, Paolicelli D, De Luca G, Tomassini V, Lanzillo R, Moccia M, Solaro C, Cocco E, Gasperini C, Tortorella C. SARS-CoV-2 vaccination and multiple sclerosis: a large multicentric study on relapse risk after the third booster dose. J Neurol 2024; 271:24-31. [PMID: 37922069 PMCID: PMC10769943 DOI: 10.1007/s00415-023-12034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND COVID-19 vaccines have been recommended to people with multiple sclerosis (pwMS) and, to ensure durable immunity, a third booster dose has been administered in several countries. Data about potential risks associated with the third booster dose in pwMS, such as vaccine-triggered disease exacerbations, are still scarce. OBJECTIVE To investigate whether the administration of a third booster dose of mRNA COVID-19 vaccines was associated with an increased risk of short-term disease reactivation in a large cohort of pwMS. METHODS We retrospectively selected 1265 pwMS who received a third booster dose of an mRNA COVID-19 vaccine. Demographic and clinical data were collected, including the presence, number and characteristics of relapses in the 60 days prior to and after the third booster dose. RESULTS In the selected cohort, the relapse rate in the two months after administration of the third booster dose of mRNA COVID-19 vaccines did not increase when compared with the prior two months. Indeed, the percentage of pwMS experiencing relapses in the 60 days following the administration of the third booster dose was 2.1%, similar to the percentage recorded in 60 days prior to vaccination, which was 1.9%. CONCLUSIONS The third booster dose of mRNA COVID-19 vaccines appeared to be safe for pwMS.
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Affiliation(s)
- Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Umbria, Italy.
| | - Diana Ferraro
- Dipartimento di Neuroscienze, Ospedale Civile di Baggiovara, Azienda Ospedaliera-Università di Modena, Modena, Italy
| | - Paolo Ragonese
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Prosperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Giorgia Teresa Maniscalco
- Centro Regionale Sclerosi Multipla, Dipartimento di Neurologia e Stroke Unit, Ospedale "A. Cardarelli", Naples, Italy
| | - Antonio Gallo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Cavalla
- Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lorena Lorefice
- Centro Sclerosi Multipla, Dipartimento di Scienze Mediche e di Sanità Pubblica, ASL Cagliari, Università di Cagliari, Ospedale Binaghi, Cagliari, Italy
| | - Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Di Sabatino
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Umbria, Italy
| | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche dell'Università di Torino, AOU San Luigi Gonzaga Di Orbassano, Orbassano, Italy
| | - Clara Guaschino
- Neurologia ad Indirizzo Neuroimmunologico-Centro Sclerosi Multipla, ASST Valle Olona, Gallarate, Italy
| | - Marta Radaelli
- U.O.C. Di Neurologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Fabio Buttari
- Dipartimento di Medicina dei Sistemi, Università di Tor Vergata, Rome, Italy
| | - Alice Laroni
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Scienze Materno-Infantili, Università di Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Massimiliano Calabrese
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Simona Malucchi
- SCDO Neurologia - CRESM, AOU San Luigi Gonzaga, Orbassano, Italy
| | - Damiano Paolicelli
- Dipartimento di Biomedicina Traslazionale e Neuroscienze, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Ospedale Universitario SS Annunziata, Chieti, Italy
| | - Valentina Tomassini
- Centro Sclerosi Multipla, Clinica Neurologica, Ospedale Universitario SS Annunziata, Chieti, Italy
- Istituto di Tecnologie Avanzate Biomediche (ITAB), Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, Facoltà di Medicina e Chirurgia, Università di Chieti-Pescara "G. D'Annunzio", Chieti, Italy
| | - Roberta Lanzillo
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Federico II, Naples, Italy
| | - Marcello Moccia
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- Centro Sclerosi Multipla, Ospedale Universitario Federico II, Naples, Italy
| | - Claudio Solaro
- Unità di Neurologia, E.O. Ospedali Galliera, Genoa, Italy
| | - Eleonora Cocco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Centro Regionale Sclerosi Multipla, ASL Cagliari, ATS Sardegna, Università di Cagliari, Cagliari, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
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Fneish F, Frahm N, Peters M, Ellenberger D, Haas J, Löbermann M, Pöhlau D, Röper AL, Schilling S, Stahmann A, Temmes H, Paul F, Zettl UK. Occurrence and Risk Factors of Relapse Activity after Vaccination against COVID-19 in People with Multiple Sclerosis: 1-Year Follow-Up Results from a Nationwide Longitudinal Observational Study. Vaccines (Basel) 2023; 11:1859. [PMID: 38140262 PMCID: PMC10747540 DOI: 10.3390/vaccines11121859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Several studies reported post-SARS-CoV-2-vaccination (PV) symptoms. Even people with multiple sclerosis (PwMS) have concerns about disease activity following the SARS-CoV-2 vaccination. We aimed to determine the proportion of PwMS with PV relapses, the PV annualized relapse rate (ARR), the time from vaccination to subsequent relapses, and identify sociodemographic/clinical risk factors for PV relapses. PwMS were surveyed several times at baseline and four follow-ups as part of a longitudinal observational study regarding the safety and tolerability of the SARS-CoV-2 vaccination. The inclusion criteria for this analysis were age ≥18 years, ≥1 SARS-CoV-2 vaccination, and ≥1-year observation period since initial vaccination. Of 2466 PwMS, 13.8% reported PV relapses (mostly after second [N = 147] or booster vaccination [N = 145]) at a median of 8.0 (first/third quantile: 3.55/18.1) weeks PV, with the shortest period following initial vaccination (3.95 weeks). The ARR was 0.153 (95% confidence interval: 0.138-0.168), with a median observation period since initial vaccination of 1.2 years. Risk factors for PV relapses were younger age, female gender, moderate-severe disability levels, concurrent autoimmune diseases, relapsing-remitting MS courses, no DMT, and relapses within the year prior to the first vaccination. Patients' health conditions before/during initial vaccination may play a more important role in PV relapse occurrence than vaccination per se.
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Affiliation(s)
- Firas Fneish
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Niklas Frahm
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, 18147 Rostock, Germany;
| | - Melanie Peters
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Gesellschaft für Versorgungsforschung mbH (Society for Health Care Research [GfV]), German MS Registry, 30171 Hannover, Germany
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Micha Löbermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University Medical Center of Rostock, 18057 Rostock, Germany;
| | - Dieter Pöhlau
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Anna-Lena Röper
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Sarah Schilling
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Herbert Temmes
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Friedemann Paul
- Experimental and Clinical Research Center, Joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, The Charité Medical Faculty, Campus Berlin-Buch, 13125 Berlin, Germany;
- Department of Neurology, Charité—Universitätsmedizin, 10117 Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin, 10117 Berlin, Germany
| | - Uwe K. Zettl
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, 18147 Rostock, Germany;
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9
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Spierer R, Lavi I, Bloch S, Mazar M, Golan D. Risk of breakthrough COVID-19 after vaccination among people with multiple sclerosis on disease-modifying therapies. J Neurol 2023; 270:4632-4639. [PMID: 37589743 DOI: 10.1007/s00415-023-11935-4] [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: 05/30/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) for people with multiple sclerosis (pwMS) may decrease vaccine effectiveness. We aimed to explore the association between various DMTs and the risk for breakthrough COVID-19. METHODS Population-based data from Clalit Health Services, Israel's largest healthcare organization, were used. PwMS treated with DMTs without prior COVID-19 were followed from the commencement of the mass vaccination campaign in December 2020. The end of follow-up was at the time of COVID-19 infection, the receipt of a third vaccine dose or until the end of August 2021. Time-dependent multivariate Cox proportional hazard models were used to estimate hazard ratios for COVID-19 according to vaccination, DMT, age, gender, disability and comorbidities. RESULTS 2511 PwMS treated with DMTs were included (Age: 46.2 ± 14.6, 70% Female, EDSS: 3.0 ± 2.1). Of whom, 2123 (84.5%) received 2 vaccine doses. On multivariate models that included all pwMS, vaccination was protective (HR = 0.41, P < 0.001). On multivariate models that included only fully vaccinated pwMS cladribine, ocrelizumab, S1P receptor modulators and natalizumab were associated with breakthrough COVID-19 (HR = 6.1, 4.7, 3.7 and 3.3; P = 0.004, 0.008, 0.02 and 0.05, respectively). On multivariate models that included unvaccinated and fully vaccinated pwMS on each DMT separately, a protective trend was noted for vaccination on all DMTs (0.09 < HR < 0.65), except for cladribine (HR = 1.1). This protective trend was not statistically significant on ocrelizumab, S1P receptor modulators and natalizumab. COVID-19 among pwMS was generally mild. Only 2 vaccinated pwMS had a severe infection with eventual recovery. CONCLUSIONS Vaccination effectively protects pwMS from COVID-19. An increased risk of breakthrough infection was noted on high-efficacy DMTs, however COVID-19 after vaccination was usually mild.
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Affiliation(s)
- Ronen Spierer
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Lady Davis Carmel Medical Center, 7 Mikhal St, 3436212, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sivan Bloch
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Lady Davis Carmel Medical Center, 7 Mikhal St, 3436212, Haifa, Israel
| | | | - Daniel Golan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
- Department of Neurology, Lady Davis Carmel Medical Center, 7 Mikhal St, 3436212, Haifa, Israel.
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel.
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10
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Doron A, Eviatar-Ribak T, Vituri A, Shahar S, Fahoum F, Goldstein L. The COVID-19 pfizer BioNTech mRNA vaccine and the frequency of seizures. Clin Neurol Neurosurg 2023; 233:107952. [PMID: 37690190 DOI: 10.1016/j.clineuro.2023.107952] [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: 07/09/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE A nationwide vaccination operation against Coronavirus disease 2019 (COVID-19) using the BNT162b2 mRNA vaccine commenced in Israel in December 2020. People older than 60 were prioritized, and most were vaccinated shortly after. Seizures are not infrequently attributed to the vaccine despite a lack of supporting evidence. People with epilepsy (PWE) are often reluctant to get the vaccine due to concerns of seizure aggravation. We aim to examine the effect of the vaccine effort on the frequency of both new-onset seizures and recurrent seizures in PWE. METHODS All adults who presented to the emergency department (ED) of Tel Aviv Sourasky Medical Center between January 1st and May 31st, 2017-2021, and were diagnosed with seizures were included. Demographic, clinical, and vaccination status parameters were collected using MDClone, a data acquisition tool. Vaccination rates in the general population were obtained from official governmental publications. Statistics included a sub-analysis of patients with the highest vaccination rate, people older than 60. RESULTS 1675 cases were included. The numbers of ED visits and hospital admissions due to seizures in 2021 were comparable to preceding years after adjusting for the total number of ED visits at the same time. Out of 339 cases in 2021, 134 patients older than 60 years old presented to the ED (39.5%) compared to 124-151 in 2017-2019 (37-44%) and 103 in 2020 (33%). The vaccination rate among patients hospitalized due to seizures was similar to the general population of the same age group during the same period in Israel. There was no temporal relation between vaccination and hospitalization due to a seizure. SIGNIFICANCE Despite very high vaccination rates in the general population in Israel and especially among people older than 60 years, no increase was observed in ED presentations due to seizures. No temporal relation was observed between vaccination and hospitalization due to a seizure. We conclude that the mass vaccination with the Pfizer BioNTech mRNA vaccine is not associated with increased seizure propensity.
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Affiliation(s)
- Alon Doron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Eviatar-Ribak
- EEG and Epilepsy Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Aya Vituri
- Tel Aviv University Center for AI and Data Science (TAD), Israel
| | - Shimon Shahar
- Tel Aviv University Center for AI and Data Science (TAD), Israel
| | - Firas Fahoum
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; EEG and Epilepsy Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lilach Goldstein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; EEG and Epilepsy Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Thomas Jefferson University, Philadelphia, USA.
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11
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Wang Q, Kang JJ, Bai Y, Oh SY. Relapse of neuromyelitis optica spectrum disorder after BNT162b2 mRNA Covid-19 vaccination. eNeurologicalSci 2023; 31:100455. [PMID: 36941823 PMCID: PMC10024163 DOI: 10.1016/j.ensci.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023] Open
Affiliation(s)
- Qi Wang
- Department of Medicine, School of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yutong Bai
- Department of Medical Science, School of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Corresponding author at: Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonbuk National University, Jeonju, Korea 20 Geonji-ro, Deokjin-gu, Jeonju-city, Jeonbuk 561-712, Republic of Korea.
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12
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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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Frahm N, Fneish F, Ellenberger D, Haas J, Löbermann M, Peters M, Pöhlau D, Röper AL, Schilling S, Stahmann A, Temmes H, Paul F, Zettl UK. Frequency and Predictors of Relapses following SARS-CoV-2 Vaccination in Patients with Multiple Sclerosis: Interim Results from a Longitudinal Observational Study. J Clin Med 2023; 12:jcm12113640. [PMID: 37297838 DOI: 10.3390/jcm12113640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Despite protection from severe COVID-19 courses through vaccinations, some people with multiple sclerosis (PwMS) are vaccination-hesitant due to fear of post-vaccination side effects/increased disease activity. The aim was to reveal the frequency and predictors of post-SARS-CoV-2-vaccination relapses in PwMS. This prospective, observational study was conducted as a longitudinal Germany-wide online survey (baseline survey and two follow-ups). Inclusion criteria were age ≥18 years, MS diagnosis, and ≥1 SARS-CoV-2 vaccination. Patient-reported data included socio-demographics, MS-related data, and post-vaccination phenomena. Annualized relapse rates (ARRs) of the study cohort and reference cohorts from the German MS Registry were compared pre- and post-vaccination. Post-vaccination relapses were reported by 9.3% PwMS (247/2661). The study cohort's post-vaccination ARR was 0.189 (95% CI: 0.167-0.213). The ARR of a matched unvaccinated reference group from 2020 was 0.147 (0.129-0.167). Another reference cohort of vaccinated PwMS showed no indication of increased post-vaccination relapse activity (0.116; 0.088-0.151) compared to pre-vaccination (0.109; 0.084-0.138). Predictors of post-vaccination relapses (study cohort) were missing immunotherapy (OR = 2.09; 1.55-2.79; p < 0.001) and shorter time from the last pre-vaccination relapse to the first vaccination (OR = 0.87; 0.83-0.91; p < 0.001). Data on disease activity of the study cohort in the temporal context are expected for the third follow-up.
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Affiliation(s)
- Niklas Frahm
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), 30171 Hannover, Germany
- Department of Neurology, Neuroimmunological Section, University Medical Center of Rostock, 18147 Rostock, Germany
| | - Firas Fneish
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), 30171 Hannover, Germany
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), 30171 Hannover, Germany
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany
| | - Micha Löbermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University Medical Center of Rostock, 18057 Rostock, Germany
| | - Melanie Peters
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), 30171 Hannover, Germany
- Gesellschaft für Versorgungsforschung mbH (Society for Health Care Research [GfV]), 30171 Hannover, Germany
| | - Dieter Pöhlau
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany
| | - Anna-Lena Röper
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), 30171 Hannover, Germany
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany
| | - Sarah Schilling
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), 30171 Hannover, Germany
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), 30171 Hannover, Germany
| | - Herbert Temmes
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a Joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Medical Faculty, Campus Berlin-Buch, 13125 Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin, 10117 Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin, 10117 Berlin, Germany
| | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunological Section, University Medical Center of Rostock, 18147 Rostock, Germany
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14
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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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15
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Stanikić M, Twomey E, Puhan MA, Kamm CP, Salmen A, Ajdacic-Gross V, Zecca C, Gobbi C, von Wyl V. Experiences of persons with multiple sclerosis with the Covid-19 vaccination: A cross-sectional study of the Swiss Multiple Sclerosis Registry. Mult Scler Relat Disord 2023; 74:104707. [PMID: 37068368 PMCID: PMC10080862 DOI: 10.1016/j.msard.2023.104707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Despite strong recommendations for coronavirus disease 2019 (Covid-19) vaccination by multiple sclerosis (MS) organizations, some persons with MS (pwMS) remain vaccine hesitant. The Swiss MS Registry conducted a survey to explore Covid-19 vaccine hesitancy, self-reported side effects and changes in MS symptoms following vaccination in adult pwMS. METHODS Self-reported data were analyzed cross-sectionally. Multivariable logistic regression was used to explore participant characteristics associated with Covid-19 vaccine hesitancy. RESULTS Of 849 respondents, 73 (8.6%) were unvaccinated. Hesitation to vaccinate was most often a personal preference (N = 42, 57.53%). Factors negatively associated with vaccine hesitancy included older age (OR = 0.97 per year, 95% CI [0.94, 0.99]) and regularly seeing healthcare professionals (OR = 0.25, 95% CI [0.07, 0.85]). A history of confirmed Covid-19 infection (OR = 3.38, 95% CI [1.69, 6.77]) and being underweight (OR = 4.50, 95% CI [1.52, 13.36]) were positively associated with vaccine hesitancy. Of 768 participants who provided information, 320 (41.2%) and 351 (45.2%) reported vaccination side effects after the first and second vaccinations, respectively. Changes in MS symptoms were reported by 49 (6.3%) participants after the first and 67 (9.0%) participants after the second vaccination, and were most often described as increased or new-onset fatigue (N = 17/49 (34.7%) after the first and N = 21/67 (31.3%) after the second dose). CONCLUSIONS Covid-19 vaccine hesitancy was low among surveyed pwMS. The risk of vaccine hesitancy was higher among younger pwMS, those with a history of Covid-19 infection, and those without regular contact with healthcare professionals.
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Affiliation(s)
- Mina Stanikić
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland; Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland
| | - Eric Twomey
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Christian P Kamm
- Neurocentre, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anke Salmen
- Neurocentre, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), Zurich, Switzerland
| | - Chiara Zecca
- Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland; Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland.
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Conway S, Saxena S, Baecher-Allan C, Krishnan R, Houtchens M, Glanz B, Saraceno TJ, Polgar-Turcsanyi M, Bose G, Bakshi R, Bhattacharyya S, Galetta K, Kaplan T, Severson C, Singhal T, Stazzone L, Zurawski J, Paul A, Weiner HL, Healy BC, Chitnis T. Preserved T cell but attenuated antibody response in MS patients on fingolimod and ocrelizumab following 2nd and 3rd SARS-CoV-2 mRNA vaccine. Mult Scler J Exp Transl Clin 2023; 9:20552173231165196. [PMID: 37057191 PMCID: PMC10086198 DOI: 10.1177/20552173231165196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/06/2023] [Indexed: 04/15/2023] Open
Abstract
Background There is limited knowledge about T cell responses in patients with multiple sclerosis (MS) after 3 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine. Objectives Assess the SARS-CoV-2 spike antibody and T cell responses in MS patients and healthy controls (HCs) after 2 doses (2-vax) and 3 doses (3-vax) of SARS-CoV-2 mRNA vaccination. Methods We studied seroconversion rates and T cell responses by flow cytometry in HC and MS patients on fingolimod or ocrelizumab. Results After 2-vax, 8/33 (24.2%) patients in ocrelizumab group, 5/7 (71.4%) in fingolimod group, and 29/29 (100%) in HC group (P = 5.7 × 10-11) seroconverted. After 3-vax, 9/22 (40.9%) patients in ocrelizumab group, 19/21 (90.5%) in fingolimod group, and 7/7 (100%) in HC group seroconverted (P = 0.0003). The percentage of SARS-CoV-2 peptide reactive total CD4+ T cells increased in HC and ocrelizumab group but not in fingolimod group after 2-vax and 3-vax (P < 0.0001). The percentage of IFNγ and TNFα producing total CD4+ and CD8+ T cells increased in fingolimod group as compared to HC and ocrelizumab group after 2-vax and 3-vax (P < 0.0001). Conclusions MS patients on ocrelizumab and fingolimod had attenuated humoral responses, but preserved cytokine producing T cell responses compared to HCs after SARS-CoV-2 mRNA vaccination. Clinical Trials Registration NCT05060354.
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Affiliation(s)
- Sarah Conway
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shrishti Saxena
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Clare Baecher-Allan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rajesh Krishnan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Maria Houtchens
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bonnie Glanz
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Taylor J Saraceno
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariann Polgar-Turcsanyi
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Gauruv Bose
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin Galetta
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tamara Kaplan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher Severson
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tarun Singhal
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lynn Stazzone
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Jonathan Zurawski
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anu Paul
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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17
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Chanprapaph K, Seree-Aphinan C, Rattanakaemakorn P, Pomsoong C, Ratanapokasatit Y, Setthaudom C, Thitithanyanont A, Suriyo A, Suangtamai T, Suchonwanit P. A real-world prospective cohort study of immunogenicity and reactogenicity of ChAdOx1-S[recombinant] among patients with immune-mediated dermatological diseases. Br J Dermatol 2023; 188:268-277. [PMID: 36637102 DOI: 10.1093/bjd/ljac045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/17/2022] [Accepted: 09/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Immunogenicity and reactogenicity of COVID-19 vaccines have been established in various groups of immunosuppressed patients; however, studies involving patients with immune-mediated dermatological diseases (IMDDs) are scarce. OBJECTIVES To investigate the influence of IMDDs on the development of SARS-CoV-2-specific immunity and side-effects following ChAdOx1-S[recombinant] vaccination. METHODS This prospective cohort study included 127 patients with IMDDs and 97 participants without immune-mediated diseases who received ChAdOx1-S[recombinant]. SARS-CoV-2-specific immunity and side-effect profiles were assessed at 1 month postvaccination and compared between groups. Immunological (primary) outcomes were the percentages of participants who tested positive for neutralizing antibodies [seroconversion rate (SR)] and those who developed T-cell-mediated immunity demonstrated by an interferon-γ-releasing assay (IGRA) [positive IGRA rate (+IGRA)]. Reactogenicity-related (secondary) outcomes were the unsolicited adverse reactions and worsening of IMDD activity reflected by the uptitration of immunosuppressants during and within 1 month of vaccination. RESULTS Overall, the SR for the IMDD group was similar to that of participants without immune-mediated conditions (75·6 vs. 84·5, P = 0·101), whereas + IGRA was lower (72·4 vs. 88·7, P = 0·003). Reactogenicity was similar between groups. No severe adverse reaction was reported. By stratifying the participants in the IMDD group according to individual disease, the immunogenicity of the vaccine was lowest in patients with autoimmune bullous diseases (AIBD) (SR 64·5%, +IGRA 62·9%) and highest in patients with psoriasis (SR 87·7%, +IGRA 80·7%). The reverse trend was found for vaccine-related reactions. Immunosuppressants were uptitrated in 15·8% of cases; 75% of these were patients with AIBD. CONCLUSIONS Among participants with IMDDs, ChAdOx1-S[recombinant] showed good immunogenicity among patients with psoriasis, but demonstrated lower levels of immunogenicity for patients with AIBD. Some patients, especially patients with AIBD, should be closely monitored as they may require treatment escalation within 1 month postvaccination.
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Affiliation(s)
| | | | | | - Cherrin Pomsoong
- Division of Dermatology, Department of Medicine, Faculty of Medicine
| | | | | | | | | | - Thanitta Suangtamai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - P Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine
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18
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Liu X, Guo K, Lu L, Luo R, Liu J, Zhou D, Hong Z. Safety of inactivated COVID-19 vaccines in autoimmune encephalitis: A real-world cross-sectional survey. Mult Scler Relat Disord 2023; 70:104495. [PMID: 36603293 PMCID: PMC9801688 DOI: 10.1016/j.msard.2022.104495] [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: 09/11/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess safety data of the inactivated COVID-19 vaccines in a real-world sample of people with autoimmune encephalitis (pwAE). METHODS A cross-sectional study was performed between 1 March and 30 April 2022. We invited pwAE from our previous ONE-WC (Outcome of Autoimmune Encephalitis Study in Western China) registration study database, to attend neurological clinics, at West China Hospital to participate in a face-to-face survey using a custom-designed questionnaire for this study. The ONE-WC study began in October 2011 and prospectively enrolled pwAE from four large comprehensive neurological centers in Sichuan province, China. RESULTS Of the 387 pwAE, 240 (62.0%) completed the questionnaire. Half the 240 participants (121, 50.4%) reported receiving at least one dose of COVID-19 vaccine, which in all but two patients received inactivated COVID-19 vaccine. Among vaccinated pwAE, the median age was 35 years (range 15-69) and 57.8% of them were women. The most frequent reasons that unvaccinated individuals reported for not receiving the COVID-19 vaccine were concern about vaccine-induced relapse of AE (50.4%) and advice from a physician to delay vaccination (21.0%). Small proportions of vaccinated individuals reported adverse events after the first dose (11.5%) or the second dose (10.2%), and none of the adverse events was serious. Across the entire sample, one individual reported relapsing within 30 days after the first dose and three individuals reported relapsing more than 120 days after the first dose. CONCLUSIONS This real-world survey indicates an overall favorable safety profile of the inactivated COVID-19 vaccine for pwAE.
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Affiliation(s)
- Xu Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Kundian Guo
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Lu Lu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jie Liu
- Department of Neurology, Sichuan Provincial Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan 611730, China.
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19
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Stefanou MI, Palaiodimou L, Theodorou A, Christodoulou MV, Tzartos JS, Tzanetakos D, Kitsos D, Chondrogianni M, Zouvelou V, Dardiotis E, Tzavellas E, Syrigou E, Benetou V, Paraskevas GP, Tsiodras S, Tsivgoulis G, Giannopoulos S. Safety of COVID-19 vaccines in multiple sclerosis: A systematic review and meta-analysis. Mult Scler 2023; 29:585-594. [PMID: 36722184 PMCID: PMC9895285 DOI: 10.1177/13524585221150881] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Data are sparse regarding the safety of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with multiple sclerosis (MS). OBJECTIVE To estimate (1) the pooled proportion of MS patients experiencing relapse among vaccine recipients; (2) the rate of transient neurological worsening, adverse events, and serious adverse events; (3) the previous outcomes of interest for different SARS-CoV-2 vaccine types. METHODS Systematic review and meta-analysis of pharmacovigilance registries and observational studies. RESULTS Nineteen observational studies comprising 14,755 MS patients who received 23,088 doses of COVID-19 vaccines were included. Mean age was 43.3 years (95% confidence interval (CI): 40-46.6); relapsing-remitting, secondary-progressive, primary-progressive MS and clinically isolated syndrome were diagnosed in 82.6% (95% CI: 73.9-89.8), 12.6% (95% CI: 6.3-20.8), 6.7% (95% CI: 4.2-9.9), and 2.9% (95% CI: 1-5.9) of cases, respectively. The pooled proportion of MS patients experiencing relapse at a mean time interval of 20 days (95% CI: 12-28.2) from vaccination was 1.9% (95% CI: 1.3%-2.6%; I2 = 78%), with the relapse risk being independent of the type of administered SARS-CoV-2-vaccine (p for subgroup differences = 0.7 for messenger RNA (mRNA), inactivated virus, and adenovector-based vaccines). After vaccination, transient neurological worsening was observed in 4.8% (95% CI: 2.3%-8.1%) of patients. Adverse events and serious adverse events were reported in 52.8% (95% CI: 46.7%-58.8%) and 0.1% (95% CI: 0%-0.2%) of vaccinations, respectively. CONCLUSION COVID-19 vaccination does not appear to increase the risk of relapse and serious adverse events in MS. Weighted against the risks of SARS-CoV-2-related complications and MS exacerbations, these safety data provide compelling pro-vaccination arguments for MS patients.
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Affiliation(s)
| | | | - Aikaterini Theodorou
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Maria Veatriki Christodoulou
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - John S Tzartos
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Dimitrios Tzanetakos
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Dimitrios Kitsos
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Eginition
Hospital, School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital
of Larissa, School of Health Sciences, Faculty of Medicine, University of
Thessaly, Larissa, Greece
| | - Elias Tzavellas
- First Department of Psychiatry, Aiginition
Hospital, School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
| | | | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and
Medical Statistics, National and Kapodistrian University of Athens, Athens,
Greece
| | - George P Paraskevas
- Second Department of Neurology, “Attikon”
University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine,
Attikon University Hospital, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
| | | | - Sotirios Giannopoulos
- S Giannopoulos Second Department of
Neurology, “Attikon” University Hospital, School of Medicine, National and
Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece.
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20
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Baars AE, Kuitwaard K, de Koning LC, Luijten LWG, Kok WM, Eftimov F, Wieske L, Goedee HS, van der Pol WL, Blomkwist-Markens PH, Horemans AMC, Jacobs BC, van Doorn PA. SARS-CoV-2 Vaccination Safety in Guillain-Barré Syndrome, Chronic Inflammatory Demyelinating Polyneuropathy, and Multifocal Motor Neuropathy. Neurology 2023; 100:e182-e191. [PMID: 36127144 DOI: 10.1212/wnl.0000000000201376] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are concerns on the safety of SARS-CoV-2 vaccination in patients with a history of Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). The aim of this study was to determine the risk of recurrence of GBS and exacerbations of CIDP or MMN after SARS-CoV-2 vaccination. METHODS We conducted a prospective, multicenter cohort study from January 2021 to August 2021. Patients known in 1 of 3 Dutch University Medical Centers with research focus on immune-mediated neuropathy and members of the Dutch Patient Association for Neuromuscular Diseases were invited to participate if they were 18 years or older and diagnosed with GBS, CIDP, or MMN. Participants completed a series of questionnaires at 4 different time points: study baseline (1), within 48 hours before any SARS-CoV-2 vaccination (2 and 3, if applicable), and 6 weeks after their last vaccination (4). Participants unwilling to get vaccinated completed the last questionnaire (4) 4 months after study baseline. We assessed recurrences of GBS, any worsening of CIDP or MMN-related symptoms, treatment alterations, and hospitalization. RESULTS Of 1,152 individuals to whom we sent the questionnaires, 674 (59%) signed informed consent. We excluded 153 individuals, most often because they had already received a SARS-CoV-2 vaccination or had had the infection (84%) before study baseline. Of 521 participants included in analyses, 403 (81%) completed the last questionnaire (time point 4). None of 162 participants with a history of GBS had a recurrence after vaccination. Of 188 participants with CIDP, 10 participants (5%) reported a worsening of symptoms within 6 weeks after vaccination. In 5 (3%) of these patients, maintenance treatment was modified. Two of 53 participants with MMN (4%) reported a worsening of symptoms, and treatment modification was reported by 1 participant. DISCUSSION We found no increased risk of GBS recurrence and a low to negligible risk of worsening of CIDP or MMN-related symptoms after SARS-CoV-2 vaccination. Based on our data, SARS-CoV-2 vaccination in patients with these immune-mediated neuropathies seems to be safe.
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Affiliation(s)
- Adája E Baars
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Krista Kuitwaard
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Laura C de Koning
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Linda W G Luijten
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W Maaike Kok
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Filip Eftimov
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Luuk Wieske
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W Ludo van der Pol
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Patricia H Blomkwist-Markens
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Anja M C Horemans
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bart C Jacobs
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Pieter A van Doorn
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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21
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Razazian N, Sahraian MA, Rezaei M, Eskandarieh S, Khamoushian K, Mousavi SE, Fakhri N. Comparison of side effects of the dose-1 of AstraZeneca and Sinopharm vaccines in patients with multiple sclerosis in Kermanshah, Iran (2021). CURRENT JOURNAL OF NEUROLOGY 2023; 22:8-15. [PMID: 38011394 PMCID: PMC10444592 DOI: 10.18502/cjn.v22i1.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2023]
Abstract
Background: Coronavirus 2019 (COVID-19) vaccination is recommended for people with multiple sclerosis (MS). This study evaluated the side effects of Sinopharm and AstraZeneca vaccines in MS patients. Methods: In this cross-sectional study among MS patients in Kermanshah province, Iran, who received Sinopharm or AstraZeneca vaccine, sampling was performed through convenience sampling according to the nationwide MS registry of Iran (NMSRI). Demographic and clinical information of the participants and data on the side effects of vaccines were collected by telephone after the first dose. The data were analyzed in SPSS software. Results: 264 vaccinated MS patients (217 with Sinopharm and 47 with AstraZeneca) were studied. In the Sinopharm and AstraZeneca groups, respectively, 58.5% and 73.3% of patients had side effects that were not significantly different between the 2 groups (P = 0.064). In the AstraZeneca group, the severity of side effects and prevalence of taking painkillers were significantly higher (P < 0.050) and the interval between vaccination and side effects onset was significantly shorter (P = 0.013). The most commonly experienced side effects in the Sinopharm group were fatigue (29.0%), myalgia (24.9%), fever (24.0%), and headache (21.7%), and in the AstraZeneca group were fever (59.6%), chills (51.1%), myalgia (40.4%), and fatigue (34.0%). Logistic regression by controlling for confounding variables showed that considering some factors as confounding factors did not show a significant difference between the 2 vaccines in the experience of side effects (P = 0.104). Conclusion: The AstraZeneca vaccine caused more severe side effects in MS patients than the Sinopharm vaccine. Most of the side effects were moderate in severity and transient.
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Affiliation(s)
- Nazanin Razazian
- Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Neuroscience Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Rezaei
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kianoosh Khamoushian
- Clinic of Multiple Sclerosis, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyede Elham Mousavi
- Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Neuroscience Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Negin Fakhri
- Neuroscience Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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22
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Capone F, Rossi M, Cruciani A, Motolese F, Pilato F, Di Lazzaro V. Safety, immunogenicity, efficacy, and acceptability of COVID-19 vaccination in people with multiple sclerosis: a narrative review. Neural Regen Res 2023; 18:284-288. [PMID: 35900404 PMCID: PMC9396498 DOI: 10.4103/1673-5374.346539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the last two years, a new severe acute respiratory syndrome coronavirus (SARS-CoV) infection has spread worldwide leading to the death of millions. Vaccination represents the key factor in the global strategy against this pandemic, but it also poses several problems, especially for vulnerable people such as patients with multiple sclerosis. In this review, we have briefly summarized the main findings of the safety, efficacy, and acceptability of Coronavirus Disease 2019 (COVID-19) vaccination for multiple sclerosis patients. Although the acceptability of COVID-19 vaccines has progressively increased in the last year, a small but significant part of patients with multiple sclerosis still has relevant concerns about vaccination that make them hesitant about receiving the COVID-19 vaccine. Overall, available data suggest that the COVID-19 vaccination is safe and effective in multiple sclerosis patients, even though some pharmacological treatments such as anti-CD20 therapies or sphingosine l-phosphate receptor modulators can reduce the immune response to vaccination. Accordingly, COVID-19 vaccination should be strongly recommended for people with multiple sclerosis and, in patients treated with anti-CD20 therapies and sphingosine l-phosphate receptor modulators, and clinicians should evaluate the appropriate timing for vaccine administration. Further studies are necessary to understand the role of cellular immunity in COVID-19 vaccination and the possible usefulness of booster jabs. On the other hand, it is mandatory to learn more about the reasons why people refuse vaccination. This would help to design a more effective communication campaign aimed at increasing vaccination coverage among vulnerable people.
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23
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Etemadifar M, Abhari AP, Nouri H, Sigari AA, Piran Daliyeh SM, Maracy MR, Salari M, Maleki S, Sedaghat N. Self-Reported safety of the BBIBP-CorV (Sinopharm) COVID-19 vaccine among Iranian people with multiple sclerosis. Hum Vaccin Immunother 2022; 18:2041945. [PMID: 35201963 PMCID: PMC9009900 DOI: 10.1080/21645515.2022.2041945] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To affirm the short-term safety of the BBIBP-CorV (Sinopharm) COVID-19 vaccine among people with multiple sclerosis (pwMS), 517 vaccinated and 174 unvaccinated pwMS were interviewed. 16.2% of the vaccinated pwMS reported at least one neurological symptom in their respective vaccine-related at-risk periods (ARP) – a period from the first dose until two weeks after the second dose of the vaccine. In a multivariable logistic regression model, the presence of comorbidities (P = 0.01), use of natalizumab (P = 0.03), and experiencing post-vaccination myalgia (P < 0.01) predicted the development of post-vaccination neurological symptoms. One MS relapse, one COVID-19 contraction, and one ulcerative colitis flare after the first dose, and four MS relapses after the second dose of the vaccine were the only reported serious adverse events during the ARPs. To show if the vaccine provoked MS relapses, we compared the relapse rate of vaccinated pwMS in the vaccine-related ARP with the annualized relapse rate of unvaccinated pwMS in the prior year—a measure of baseline MS relapsing activity in the respective time—using a multivariable Poisson regression model accounting for possible confounders, which failed to show any statistically significant increase (P = 0.78). Hence, subject to replication—as the vaccinated and unvaccinated pwMS differed in baseline characteristics—the BBIBP-CorV vaccine does not seem to affect short-term MS activity. Furthermore, as 83.33% of the unvaccinated pwMS reported fear of possible adverse events to be the reason of their vaccination hesitancy, provision of evidence-based consultations to pwMS is encouraged. Limitations of our study briefly included lack of data for self-controlled analysis of relapse rates, possible presence of recall bias, and lack of on-site validations regarding the clinical outcomes due to the remote nature.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Alzahra Research Institute, Alzahra University Hospital, 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), 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), Iran
| | - Amirhossein Akhavan Sigari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Maleki
- Alzahra Research Institute, Alzahra University Hospital, 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), Iran
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24
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Räuber S, Willison A, Korsen M, Kölsche T, Golombeck KS, Plaack B, Schüller J, Huntemann N, Rolfes L, Schroeter CB, Nelke C, Regner-Nelke L, Förster M, Ringelstein M, Barnett MH, Hartung HP, Aktas O, Albrecht P, Ruck T, Melzer N, Meuth SG, Kremer D. Vaccine-based clinical protection against SARS-CoV-2 infection and the humoral immune response: A 1-year follow-up study of patients with multiple sclerosis receiving ocrelizumab. Front Immunol 2022; 13:1037214. [PMID: 36618356 PMCID: PMC9822773 DOI: 10.3389/fimmu.2022.1037214] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Given the varying severity of coronavirus disease 2019 (COVID-19) and the rapid spread of Severe-Acute-Respiratory-Syndrome-Corona-Virus-2 (SARS-CoV-2), vaccine-mediated protection of particularly vulnerable individuals has gained increasing attention during the course of the pandemic. Methods We performed a 1-year follow-up study of 51 ocrelizumab-treated patients with multiple sclerosis (OCR-pwMS) who received COVID-19 vaccination in 2021. We retrospectively identified 37 additional OCR-pwMS, 42 pwMS receiving natalizumab, 27 pwMS receiving sphingosine 1-phosphate receptor modulators, 59 pwMS without a disease-modifying therapy, and 61 controls without MS (HC). In OCR-pwMS, anti-SARS-CoV-2(S)-antibody titers were measured prior to the first and after the second, third, and fourth vaccine doses (pv2/3/4). The SARS-CoV-2-specific T cell response was analyzed pv2. SARS-CoV-2 infection status, COVID-19 disease severity, and vaccination-related adverse events were assessed in all pwMS and HC. Results We found a pronounced and increasing anti-SARS-CoV-2(S)-antibody response after COVID-19 booster vaccinations in OCR-pwMS (pv2: 30.4%, pv3: 56.5%, and pv4 90.0% were antibody positive). More than one third of OCR-pwMS without detectable antibodies pv2 developed positive antibodies pv3. 23.5% of OCR-pwMS had a confirmed SARS-CoV-2 infection, of which 84.2% were symptomatic. Infection rates were comparable between OCR-pwMS and control groups. None of the pwMS had severe COVID-19. An attenuated humoral immune response was not associated with a higher risk of SARS-CoV-2 infection. Discussion Additional COVID-19 vaccinations can boost the humoral immune response in OCR-pwMS and improve clinical protection against COVID-19. Vaccines effectively protect even OCR-pwMS without a detectable COVID-19 specific humoral immune response, indicating compensatory, e.g., T cell-mediated immunological mechanisms.
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Affiliation(s)
- Saskia Räuber
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alice Willison
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Melanie Korsen
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tristan Kölsche
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kristin S. Golombeck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Benedikt Plaack
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julia Schüller
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Leoni Rolfes
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christina B. Schroeter
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christopher Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Liesa Regner-Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Moritz Förster
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany,Brain and Mind Center, University of Sydney, Sydney, NSW, Australia,Department of Neurology, Medical University of Vienna, Vienna, Austria,Department of Neurology, Palacky University, Olomouc, Czechia
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nico Melzer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - David Kremer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany,*Correspondence: David Kremer,
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25
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Tavazzi E, Della Porta G, Robustelli Della Cuna FS, Gervasio L, Guerra E, Tejada Condemayta MA, Filosa A, Montomoli C, Bergamaschi R. Quantitative and qualitative features of acute phase-adverse events following SARS-CoV-2 vaccination in a large sample of people with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104120. [PMID: 35988330 PMCID: PMC9376979 DOI: 10.1016/j.msard.2022.104120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Few data are available on adverse events (AE) associated to vaccines in persons with multiple sclerosis (pwMS). AIMS to study the incidence of acute phase AE (AP-AE) related to SARS-CoV-2 mRNA vaccines in pwMS compared to a control group, and to analyze the association between AP-AE and disease modifying treatments (DMT). METHODS This was a cross-sectional study on 438 PwMS and 481 age- and sex-matched subjects not affected by dysimmune diseases that underwent two doses of SARS-CoV-2 mRNA BNT162b2 vaccine (Pfizer/BioNtech). RESULTS Two hundred and twenty five (51.4%) pwMS complained of ≥1 AP-AE after the first dose, 269 (61.4%) after the second dose. A logistic regression analysis revealed that only pwMS on Fingolimod and Ocrelizumab did not show a higher risk of developing AP-AE. The likelihood to present with ≥1 AP-AE, after correcting for age and sex, was significantly higher in pwMS than controls. CONCLUSIONS This study reports qualitative and quantitative features of AP-AE associated with the first and second doses of SARS-CoV-2 vaccine in a large sample of pwMS. The only risk factor identified for developing AP-AE is female gender. AntiCD-20 monoclonal antibodies and S1P inhibitors are associated with a lower risk of AP-AE occurrence.
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Affiliation(s)
- E Tavazzi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy.
| | - G Della Porta
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy
| | - F S Robustelli Della Cuna
- Department of Drug Sciences, University of Pavia, Pavia, Italy; Pharmacy Service, IRCCS Mondino Foundation, Pavia, Italy
| | - L Gervasio
- Pharmacy Service, IRCCS Mondino Foundation, Pavia, Italy
| | - E Guerra
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - M A Tejada Condemayta
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy
| | - A Filosa
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - C Montomoli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - R Bergamaschi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy
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26
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Kong L, Wang X, Chen H, Shi Z, Lang Y, Zhang Y, Zhou H. Relapses after SARS-CoV-2 vaccination in patients with neuromyelitis optica spectrum disorder and multiple sclerosis. Mult Scler Relat Disord 2022; 68:104167. [PMID: 36170773 PMCID: PMC9472679 DOI: 10.1016/j.msard.2022.104167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic outbreak raises the question of whether immunization is recommended for patients with CNS demyelinating diseases. On the one hand, existing studies suggested that SARS-CoV-2 vaccinations are not associated with increased risk of relapse activity. On the other hand, case reports with acute CNS demyelinating disease post vaccination were emerging and raising clinicians' attention. METHODS In this longitudinal observational study, we included 556 patients with neuromyelitis optica spectrum disorder (NMOSD) and 280 patients with relapsing-remitting multiple sclerosis (RRMS). Each vaccinated patient was matched to two unvaccinated patients according to age, gender, ARR and immunotherapy status, based on propensity score matching model (PSM). The primary outcome is the short- and medium-term risk of relapse, which were evaluated by Kaplan-Meier analysis between groups. RESULTS In our cohort, 649 patients (77.6%) have not yet been vaccinated, mainly due to their concerns about relapse. After PSM, 109 vaccinated patients with NMOSD, 218 PS-matched unvaccinated patients with NMOSD, 78 vaccinated patients with RRMS, and 156 PS-matched unvaccinated patients with RRMS were included in the survival analysis to explore the safety of vaccines, with a median of 9-month follow-up. Following the first vaccination dose, 10 patients with NMOSD (9.2%) and four with RRMS (5.1%) experienced an acute relapse. Meanwhile, in the PS-matched unvaccinated group, 15 patients with NMOSD (6.9%) and 12 patients with RRMS (7.7%) presented with an acute relapse. There was no significant difference between the two curves in both NMOSD and RRMS groups over the course of the observation period. There were no significant differences in demographic characteristics, clinical characteristics, and symptoms of relapses between the vaccinated and PS-matched unvaccinated groups. Post vaccination adverse events (ADE) were reported in 39 individuals (20.9%). CONCLUSION Our results indicate that inactivated SARS-CoV-2 vaccines appear safe for patients with CNS demyelinating diseases.
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27
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The Safety Profile of COVID-19 Vaccines in Patients Diagnosed with Multiple Sclerosis: A Retrospective Observational Study. J Clin Med 2022; 11:jcm11226855. [PMID: 36431332 PMCID: PMC9692274 DOI: 10.3390/jcm11226855] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
In the current COVID-19 pandemic, patients diagnosed with multiple sclerosis (MS) are considered to be one of the highest priority categories, being recognized as extremely vulnerable people. For this reason, mRNA-based COVID-19 vaccines are strongly recommended for these patients. Despite encouraging results on the efficacy and safety profile of mRNA-based COVID-19 vaccines, to date, in frail populations, including patients diagnosed with MS, this information is rather limited. We carried out a retrospective observational study with the aim to evaluate the safety profile of mRNA-based COVID-19 vaccines by retrieving real-life data of MS patients who were treated and vaccinated at the Multiple Sclerosis Center of the Hospital A.O.R.N. A. Cardarelli. Three-hundred and ten medical records of MS patients who received the first dose of the mRNA-based COVID-19 vaccine were retrieved (63% female; mean age: 45.9 years). Of these patients, 288 also received the second dose. All patients received the Pfizer-BioNTech vaccine. Relapsing-Remitting Multiple Sclerosis (RRSM) was the most common form of MS. The Expanded Disability Status Scale (EDSS) values were <3.0 in 70% of patients. The majority of patients received a Disease Modifying Therapy (DMT) during the study period, mainly interferon beta 1-a, dimethyl fumarate, and natalizumab and fingolimod. Overall, 913 AEFIs were identified, of which 539 were after the first dose of the vaccine and 374 after the second dose. The majority of these AEFIs were classified as short-term since they occurred within the first 72 h. The most common identified adverse events were pain at injection site, flu-like symptoms, and headache. Fever was reported more frequently after the second dose than after the first dose. SARS-CoV-2 infection occurred in 3 patients after the first dose. Using historical data of previous years (2017−2020), the relapses’ rate during 2021 was found to be lower. Lastly, the results of the multivariable analysis that assessed factors associated with the occurrence of AEFIs revealed a statistical significance for age, sex, and therapy with ocrelizumab (p < 0.05). In conclusion, our results indicated that Pfizer-BioNTech vaccine was safe for MS patients, being associated with AEFIs already detected in the general population. Larger observational studies with longer follow-up and epidemiological studies are strongly needed.
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28
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Frahm N, Fneish F, Ellenberger D, Haas J, Loebermann M, Parciak T, Peters M, Pöhlau D, Rodgers J, Röper AL, Schilling S, Stahmann A, Temmes H, Zettl UK, Middleton RM. SARS-CoV-2 vaccination in patients with multiple sclerosis in Germany and the United Kingdom: Gender-specific results from a longitudinal observational study. Lancet Reg Health Eur 2022; 22:100502. [PMID: 36090519 PMCID: PMC9438509 DOI: 10.1016/j.lanepe.2022.100502] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Niklas Frahm
- German MS-Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]) Krausenstr. 50, 30171 Hannover, Germany
- Department of Neurology, Neuroimmunological Section, University Medical Center of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
- Corresponding author at: MS Research and Project Development gGmbH, Krausenstr. 50, 30171 Hannover, Germany.
| | - Firas Fneish
- German MS-Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]) Krausenstr. 50, 30171 Hannover, Germany
| | - David Ellenberger
- German MS-Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]) Krausenstr. 50, 30171 Hannover, Germany
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), Krausenstr. 50, 30171 Hannover, Germany
| | - Micha Loebermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University Medical Center of Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Tina Parciak
- Biomedical Research Institute & Data Science Institute, Hasselt University, Diepenbeek 3590, Belgium
| | - Melanie Peters
- Gesellschaft für Versorgungsforschung mbH (Society for Health Care Research [GfV]), Krausenstr. 50, 30171 Hannover, Germany
| | - Dieter Pöhlau
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), Krausenstr. 50, 30171 Hannover, Germany
| | - Jeff Rodgers
- UK MS Register, Swansea University Medical School, Data Science Building, Swansea SA2 8PP, United Kingdom
| | - Anna-Lena Röper
- German MS-Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]) Krausenstr. 50, 30171 Hannover, Germany
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), Krausenstr. 50, 30171 Hannover, Germany
| | - Sarah Schilling
- German MS-Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]) Krausenstr. 50, 30171 Hannover, Germany
| | - Alexander Stahmann
- German MS-Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]) Krausenstr. 50, 30171 Hannover, Germany
| | - Herbert Temmes
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), Krausenstr. 50, 30171 Hannover, Germany
| | - Uwe K. Zettl
- Department of Neurology, Neuroimmunological Section, University Medical Center of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Rodden M. Middleton
- UK MS Register, Swansea University Medical School, Data Science Building, Swansea SA2 8PP, United Kingdom
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29
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Räuber S, Korsen M, Huntemann N, Rolfes L, Müntefering T, Dobelmann V, Hermann AM, Kölsche T, von Wnuck Lipinski K, Schroeter CB, Nelke C, Regner-Nelke L, Ingwersen J, Pawlitzki M, Teegen B, Barnett MH, Hartung HP, Aktas O, Albrecht P, Levkau B, Melzer N, Ruck T, Meuth SG, Kremer D. Immune response to SARS-CoV-2 vaccination in relation to peripheral immune cell profiles among patients with multiple sclerosis receiving ocrelizumab. J Neurol Neurosurg Psychiatry 2022; 93:978-985. [PMID: 35193952 PMCID: PMC8889453 DOI: 10.1136/jnnp-2021-328197] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vaccination has proven to be effective in preventing SARS-CoV-2 transmission and severe disease courses. However, immunocompromised patients have not been included in clinical trials and real-world clinical data point to an attenuated immune response to SARS-CoV-2 vaccines among patients with multiple sclerosis (MS) receiving immunomodulatory therapies. METHODS We performed a retrospective study including 59 ocrelizumab (OCR)-treated patients with MS who received SARS-CoV-2 vaccination. Anti-SARS-CoV-2-antibody titres, routine blood parameters and peripheral immune cell profiles were measured prior to the first (baseline) and at a median of 4 weeks after the second vaccine dose (follow-up). Moreover, the SARS-CoV-2-specific T cell response and peripheral B cell subsets were analysed at follow-up. Finally, vaccination-related adverse events were assessed. RESULTS After vaccination, we found anti-SARS-CoV-2(S) antibodies in 27.1% and a SARS-CoV-2-specific T cell response in 92.7% of MS cases. T cell-mediated interferon (IFN)-γ release was more pronounced in patients without anti-SARS-CoV-2(S) antibodies. Antibody titres positively correlated with peripheral B cell counts, time since last infusion and total IgM levels. They negatively correlated with the number of previous infusion cycles. Peripheral plasma cells were increased in antibody-positive patients. A positive correlation between T cell response and peripheral lymphocyte counts was observed. Moreover, IFN-γ release was negatively correlated with the time since the last infusion. CONCLUSION In OCR-treated patients with MS, the humoral immune response to SARS-CoV-2 vaccination is attenuated while the T cell response is preserved. However, it is still unclear whether T or B cell-mediated immunity is required for effective clinical protection. Nonetheless, given the long-lasting clinical effects of OCR, monitoring of peripheral B cell counts could facilitate individualised treatment regimens and might be used to identify the optimal time to vaccinate.
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Affiliation(s)
- Saskia Räuber
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Melanie Korsen
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Leoni Rolfes
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Thomas Müntefering
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Vera Dobelmann
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander M Hermann
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tristan Kölsche
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Karin von Wnuck Lipinski
- Institute of Molecular Medicine III, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christina B Schroeter
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christopher Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Liesa Regner-Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jens Ingwersen
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bianca Teegen
- Clinical Immunological Laboratory Prof. Dr. med. Winfried Stöcker, Lübeck, Germany
| | - Michael Harry Barnett
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Neuroimaging Analysis Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, Palacky University, Olomouc, Czech Republic
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bodo Levkau
- Institute of Molecular Medicine III, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nico Melzer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - David Kremer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Stastna D, Menkyova I, Drahota J, Hrnciarova T, Kubala Havrdova E, Vachova M, Andelova M, Kleinova P, Kovarova I, Krasulova E, Preiningerova JL, Novakova I, Novotna K, Novotna M, Nytrova P, Pavlickova J, Srpova B, Storey K, Ticha V, Tyblova M, Uher T, Vodehnalova K, Horakova D. To be or not to be vaccinated: The risk of MS or NMOSD relapse after COVID-19 vaccination and infection. Mult Scler Relat Disord 2022; 65:104014. [PMID: 35803085 PMCID: PMC9250417 DOI: 10.1016/j.msard.2022.104014] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/08/2022] [Accepted: 07/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND COVID-19 vaccination and infection are speculated to increase the activity of immune-mediated diseases, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). The aim of this study was to evaluate a short-term risk of relapse after COVID-19 vaccination and COVID-19 infection in patients with these demyelinating disorders of the central nervous system and to determine disease exacerbation risk factors. METHODS Data in this retrospective, observational cohort study was collected via the Czech nationwide registry ReMuS from March 1, 2020, to October 30, 2021. We compared the proportion of patients with at least one clinical relapse in the 90 days following vaccination or infection to the 90-day intervals during the year before. For the evaluation of the risk factors of relapse, a comparison between groups with and without relapses after COVID-19 vaccination or infection was made. RESULTS We identified 1661 vaccinated (90.11% BNT162b2) patients with MS without a history of COVID-19 and 495 unvaccinated patients with MS who experienced COVID-19. A mild increase in the proportion of patients with at least one clinical relapse (-360 to -270 days: 4.46%; -270 to -180: 4.27%; -180 to -90: 3.85%; -90 to 0: 3.79% vs. 0 to +90 days: 5.30%) after vaccination in patients with MS was observed, as well as a rise in the proportion of patients with at least one clinical relapse after COVID-19. Lower age was associated with MS relapse after vaccination or infection. Although there were only 17 vaccinated and eight post-COVID-19 patients with NMOSD, the results were broadly consistent with those of patients with MS. CONCLUSION There is a mild increase in the relapse incidence after the COVID-19 vaccination. The risks, however, need to be balanced against the risks of COVID-19 itself, also leading to the rise in relapse rate and particularly to morbidity and mortality.
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Affiliation(s)
- Dominika Stastna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ingrid Menkyova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia; 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jiri Drahota
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia; Endowment Fund IMPULS, Prague, Czechia
| | - Tereza Hrnciarova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Eva Kubala Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Marta Vachova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia; Department of Neurology, KZ a.s., Hospital Teplice, Teplice, Czechia
| | - Michaela Andelova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Pavlina Kleinova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ivana Kovarova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Eva Krasulova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Jana Lizrova Preiningerova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Iveta Novakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Klara Novotna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Martina Novotna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Petra Nytrova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Jana Pavlickova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Barbora Srpova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Katerina Storey
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Veronika Ticha
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Michaela Tyblova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Tomas Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Karolina Vodehnalova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Dana Horakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia.
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Safety of COVID-19 Vaccines: Spotlight on Neurological Complications. Life (Basel) 2022; 12:life12091338. [PMID: 36143376 PMCID: PMC9502976 DOI: 10.3390/life12091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has led to unprecedented demand on the global healthcare system. Remarkably, at the end of 2021, COVID-19 vaccines received approvals for human use in several countries worldwide. Since then, a solid base for response in the fight against the virus has been placed. COVID-19 vaccines have been shown to be safe and effective drugs. Nevertheless, all kinds of vaccines may be associated with the possible appearance of neurological complications, and COVID-19 vaccines are not free from neurological side effects. Neurological complications of COVID-19 vaccination are usually mild, short-duration, and self-limiting. However, severe and unexpected post-vaccination complications are rare but possible events. They include the Guillain-Barré syndrome, facial palsy, other neuropathies, encephalitis, meningitis, myelitis, autoimmune disorders, and cerebrovascular events. The fear of severe or fatal neurological complications fed the “vaccine hesitancy” phenomenon, posing a vital communication challenge between the scientific community and public opinion. This review aims to collect and discuss the frequency, management, and outcome of reported neurological complications of COVID-19 vaccines after eighteen months of the World Health Organization’s approval of COVID-19 vaccination, providing an overview of safety and concerns related to the most potent weapon against the SARS-CoV-2.
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Alroughani R, Al-Hashel J, Abokalawa F, AlMojel M, Ahmed S. UCOVID-19 vaccination in people with multiple sclerosis, real-life Experience. Clin Neurol Neurosurg 2022; 220:107374. [PMID: 35961255 PMCID: PMC9293951 DOI: 10.1016/j.clineuro.2022.107374] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/18/2022] [Accepted: 07/09/2022] [Indexed: 11/18/2022]
Abstract
Background Vaccination against the severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2) virus is recommended in multiple sclerosis (MS) to reduce the risk of complications from Coronavirus disease 2019 (COVID-19) infection. These vaccines were not investigated in people with MS (PWMS). Objective This study aimed to report the short-term safety of the COVID-19 vaccines among PWMS. Methods Pfizer-BioNTech mRNA (BNT162b2) vaccine and Oxford-Astra Zenecaa chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine have been approved to be used in Kuwait since December 2021. PWMS registered in Kuwait national registry were contacted by phone, WhatsApp, or through face-to-face interviews and were invited to complete our questionnaire. Demographic, clinical data, symptoms following the vaccine, worsening of pre-existing MS symptoms, and occurrence of relapse were recorded. Results Of the 820 PWMS, 647 completed the questionnaire. Between January 2021 and 31 August 2021, 383 (59.28%) PWMS received at least one dose of the approved vaccinations versus 63.4% of the general population on the same date. Their mean age was 36.82 + 8.80, and most of them, 247 (64.3%), were females. A total of 356 vaccinated cohorts (92.6%) were treated with disease-modifying therapies. Adverse events were reported by 261 (68.15%) subjects. One case of COVID-19 infection was encountered after the first dose of the BNT162b2 vaccine. Twenty-one (5.48%) cases reported worsening of pre-existing MS symptoms after the vaccine. Five patients (1.31%) reported relapse after the COVID-19 vaccine. The most common adverse events of the COVID-19 vaccine were pain at the injection site, fatigue, low-grade fever, and body ache; and resolved within one week. There was no significant association between use of disease modifying therapy (DMT) and COVID-19 vaccine adverse events. Conclusion BNT162b2 and ChAdOx1 nCoV-19 are safe for PWMS. No increased risk of relapse activity or worsening of pre-existing MS symptoms.
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Allen-Philbey K, Stennett A, Begum T, Johnson AC, MacDougall A, Green S, Dobson R, Giovannoni G, Gnanapavan S, Marta M, Smets I, Turner BP, Baker D, Mathews J, Schmierer K. Did it hurt? COVID-19 vaccination experience in people with multiple sclerosis. Mult Scler Relat Disord 2022; 65:104022. [PMID: 35816953 PMCID: PMC9250705 DOI: 10.1016/j.msard.2022.104022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
Background Current guidelines recommend vaccination against SARS-CoV2 for people with multiple sclerosis (pwMS). The long-term review of the safety and effectiveness of COVID-19 vaccines in pwMS is limited. Methods Service re-evaluation. PwMS using the MS service at Barts Health National Health Service Trust were sent questionnaires via email to report symptoms following first and second COVID-19 vaccinations (n = 570). A retrospective review of electronic health records was conducted for clinical and safety data post-vaccination(s); cut-off was end of September 2021. Separate logistic regressions were carried out for symptoms experienced at each vaccination. Two sets of regressions were fitted with covariates: (i) Disease-modifying therapy type and (ii) patient characteristics for symptoms experienced. Results 193/570 pwMS responded. 184 pwMS had both vaccinations. 144 received the AZD1222 and 49 the BNT162b2 vaccine. 87% and 75% of pwMS experienced any symptoms at first and second vaccinations, respectively. The majority of symptoms resolved within a short timeframe. No severe adverse effects were reported. Two pwMS subsequently died; one due to COVID-19 and one due to aspiration pneumonia. Males were at a reduced risk of reporting symptoms at first vaccination. There was evidence that pwMS in certain treatment groups were at reduced risk of reporting symptoms at second vaccination only. Conclusions Findings are consistent with our preliminary data. Symptoms post-vaccination were similar to the non-MS population and were mostly temporary. It is important to inform the MS community of vaccine safety data.
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Affiliation(s)
- K Allen-Philbey
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Stennett
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK; Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, UK
| | - T Begum
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A C Johnson
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A MacDougall
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, UK
| | - S Green
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - R Dobson
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK; Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, UK
| | - G Giovannoni
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK; Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, UK
| | - S Gnanapavan
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Marta
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - I Smets
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - B P Turner
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Baker
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK
| | - J Mathews
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Schmierer
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK.
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Holroyd KB, Healy BC, Conway S, Houtchens M, Bakshi R, Bhattacharyya S, Bose G, Galetta K, Kaplan T, Severson C, Singhal T, Stazzone L, Zurawski J, Polgar-Turcsanyi M, Saxena S, Paul A, Glanz BI, Weiner HL, Chitnis T. Humoral response to COVID-19 vaccination in MS Patients on Disease Modifying Therapy: Immune Profiles and Clinical Outcomes. Mult Scler Relat Disord 2022; 67:104079. [PMID: 35952457 PMCID: PMC9330583 DOI: 10.1016/j.msard.2022.104079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022]
Abstract
Background Methods Results Conclusions
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35
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SeyedAlinaghi S, Karimi A, Pashaei Z, Afzalian A, Mirzapour P, Ghorbanzadeh K, Ghasemzadeh A, Dashti M, Nazarian N, Vahedi F, Tantuoyir MM, Shamsabadi A, Dadras O, Mehraeen E. Safety and Adverse Events Related to COVID-19 mRNA Vaccines; a Systematic Review. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e41. [PMID: 35765616 PMCID: PMC9206826 DOI: 10.22037/aaem.v10i1.1597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Knowledge of vaccine-related adverse events is crucial as they are among the most important factors that cause hesitation in receiving vaccines. Therefore, we aimed to systematically review the adverse events related to the mRNA vaccines reported in the literature. Method: A systematic literature search was carried out in the databases of Scopus, PubMed, Cochrane, and Web of Science. We selected original studies that explored the side effects of mRNA COVID-19 vaccines using a two-phase (title/abstract and full-text) screening process. Results: Cardiac complications were the most commonly reported severe adverse events. It appeared that systemic adverse reactions are more common after the second dose of vaccines. The number of adverse effects reported after the Pfizer vaccine was higher than other vaccines, mostly due to its earlier approval and more widespread use throughout the world. Cardiac adverse events had a higher prevalence but no significant association has been found between COVID-19 mRNA vaccines and cardiac adverse events except for myopericarditis. Conclusion: Vaccines play a crucial role in controlling the COVID-19 pandemic and decreasing mortalities and the results of the present review acknowledge the fact that the benefits outweigh the adverse events of these vaccines.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Pashaei
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Arian Afzalian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Mirzapour
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Kobra Ghorbanzadeh
- Department of Nursing, Khalkhal University of Medical Sciences; Khalkhal, Iran
| | - Afsaneh Ghasemzadeh
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Dashti
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Farzin Vahedi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Marcarious M Tantuoyir
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Biomedical Engineering Unit, University of Ghana Medical Center (UGMC), Accra, Ghana
| | - Ahmadreza Shamsabadi
- Department of Health Information Technology, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Omid Dadras
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.,School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
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Safety of Vaccines against SARS-CoV-2 among Polish Patients with Multiple Sclerosis Treated with Disease-Modifying Therapies. Vaccines (Basel) 2022; 10:vaccines10050763. [PMID: 35632519 PMCID: PMC9147677 DOI: 10.3390/vaccines10050763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
(1) Background: The present study aims to report the side effects of vaccination against coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) who were being treated with disease-modifying therapies (DMTs) in Poland. (2) Methods: The study included 2261 patients with MS who were being treated with DMTs, and who were vaccinated against COVID-19 in 16 Polish MS centers. The data collected were demographic information, specific MS characteristics, current DMTs, type of vaccine, side effects after vaccination, time of side-effect symptom onset and resolution, applied treatment, relapse occurrence, and incidence of COVID-19 after vaccination. The results were presented using maximum likelihood estimates of the odds ratio, t-test, Pearson’s chi-squared test, Fisher’s exact p, and logistic regression. The statistical analyses were performed using STATA 15 software. (3) Of the 2261 sampled patients, 1862 (82.4%) were vaccinated with nucleoside-modified messenger RNA (mRNA) vaccines. Mild symptoms after immunization, often after the first dose, were reported in 70.6% of individuals. Symptoms included arm pain (47.5% after the first dose and 38.7% after the second dose), fever/chills/flu-like symptoms (17.1% after the first dose and 20.5% after the second dose), and fatigue (10.3% after the first dose and 11.3% after the second dose). Only one individual presented with severe side effects (pro-thrombotic complications) after vaccination. None of the DMTs in the presented cohort were predisposed to the development of side effects. Nine patients (0.4%) had a SARS-CoV-2 infection confirmed despite vaccination. (4) Conclusions: Vaccination against SARS-CoV-2 is safe for people with MS who are being treated with DMTs. Most adverse events following vaccination are mild and the acute relapse incidence is low.
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Dinoto A, Gastaldi M, Iorio R, Marini S, Damato V, Farina A, Zoccarato M, Sechi E, Pinna F, Maniscalco GT, Barnabei R, Zuliani L, Ferrari S, Mariotto S. Safety profile of SARS-CoV-2 vaccination in patients with antibody-mediated CNS disorders. Mult Scler Relat Disord 2022; 63:103827. [PMID: 35508101 PMCID: PMC9035564 DOI: 10.1016/j.msard.2022.103827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/11/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022]
Abstract
Objectives: In this retrospective multicenter study, we evaluated the safety of SARS-CoV-2 vaccination in patients harboring autoantibodies targeting neuronal surface and/or synaptic antigens. Methods: From eight Italian Neurology Units, we included patients with: a) serum and/or CSF positivity for specific neuronal autoantibodies; b) a compatible neurological syndrome; and c) available follow-up ≥6 weeks after vaccination with any of the approved SARS-CoV-2 vaccines. Demographics, clinical data, and information regarding previous SARS-CoV-2 infection and vaccination were collected. Disease relapses were considered “post-infectious” or “post-vaccination” when occurring within 6 weeks from infection/vaccination. Results: We included 66 patients; 7/66 (11%) had a previous history of SARS-CoV-2 infection and 1/7 (14%) had post-infection relapses. BNT162b2-Pfizer-BioNTec was administered in 55 cases (83.3%) and mRNA-1273-Moderna in 11 (16.7%). The median number of doses administered per patient was 2 (1–3) and >50% of patients did not experience side effects. Five patients (8%) had post-vaccination relapses (seizure 3/5); 4/5 improved after immunotherapy, while one did not receive immunotherapy and worsened. Patients with post-vaccination relapses had higher disability scores at vaccination (p = 0.025), a trend favoring Leucine-rich glioma-inactivated protein 1 LGI1 glutamic acid decarboxylase 65 (GAD65) antibodies (p = 0.054) and shorter time from last relapse (p = 0.057). Discussion: Our data support the safety of SARS-CoV-2 vaccines in patients with neurological disorders associated with antibodies to neuronal and synaptic antigens.
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Affiliation(s)
- Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Raffaele Iorio
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sofia Marini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Damato
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Antonio Farina
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Marco Zoccarato
- UOC Neurologia O.S.A. - Azienda Ospedale Università Di Padova, Padua, Italy
| | - Elia Sechi
- Azienda Ospedaliera Universitaria Sassari, Unit of Neurology, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Francesca Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgia Teresa Maniscalco
- Neurological Clinic and Stroke Unit, Multiple Sclerosis Center, "A. Cardarelli" Hospital, Naples, Italy
| | | | | | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Milo R, Staun-Ram E, Karussis D, Karni A, Hellmann MA, Bar-Haim E, Miller A. Humoral and Cellular Immune Responses to SARS-CoV-2 mRNA Vaccination in Patients with Multiple Sclerosis: An Israeli Multi-Center Experience Following 3 Vaccine Doses. Front Immunol 2022; 13:868915. [PMID: 35432335 PMCID: PMC9012137 DOI: 10.3389/fimmu.2022.868915] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/04/2022] [Indexed: 12/17/2022] Open
Abstract
Background Immunomodulatory/immunosuppressive activity of multiple sclerosis (MS) disease modifying therapies (DMTs) might affect immune responses to SARS-CoV-2 exposure or vaccination in patients with MS (PwMS). We evaluated the effect of DMTs on humoral and cell-mediated immune responses to 2 and 3 vaccinations and the longevity of SARS-Cov-2 IgG levels in PwMS. Methods 522 PwMS and 68 healthy controls vaccinated with BNT162b2-Pfizer mRNA vaccine against SARS-CoV-2, or recovering from COVID-19, were recruited in a nation-wide multi-center study. Blood was collected at 3 time-points: 2-16 weeks and ~6 months post 2nd vaccination and 1-16 weeks following 3rd vaccination. Serological responses were measured by quantifying IgG levels against the spike-receptor-binding-domain of SARS-CoV-2, and cellular responses (in a subgroup analysis) by quantifying IFNγ secretion in blood incubated with COVID-19 spike-antigen. Results 75% PwMS were seropositive post 2nd or 3rd vaccination. IgG levels decreased by 82% within 6 months from vaccination (p<0.0001), but were boosted 10.3 fold by the 3rd vaccination (p<0.0001), and 1.8 fold compared to ≤3m post 2nd vaccination (p=0.025). Patients treated with most DMTs were seropositive post 2nd and 3rd vaccinations, however only 38% and 44% of ocrelizumab-treated patients and 54% and 46% of fingolimod-treated patients, respectively, were seropositive. Similarly, in COVID-19-recovered patients only 54% of ocrelizumab-treated, 75% of fingolimod-treated and 67% of cladribine-treated patients were seropositive. A time interval of ≥5 months between ocrelizumab infusion and vaccination was associated with higher IgG levels (p=0.039 post-2nd vaccination; p=0.036 post-3rd vaccination), and with higher proportions of seropositive patients. Most fingolimod- and ocrelizumab-treated patients responded similarly to 2nd and 3rd vaccination. IFNγ-T-cell responses were detected in 89% and 63% of PwMS post 2nd and 3rd vaccination, however in only 25% and 0% of fingolimod-treated patients, while in 100% and 86% of ocrelizumab-treated patients, respectively. Conclusion PwMS treated with most DMTs developed humoral and T-cell responses following 2 and 3 mRNA SARS-CoV-2 vaccinations. Fingolimod- or ocrelizumab-treated patients had diminished humoral responses, and fingolimod compromised the cellular responses, with no improvement after a 3rd booster. Vaccination following >5 months since ocrelizumab infusion was associated with better sero-positivity. These findings may contribute to the development of treatment-stratified vaccination guidelines for PwMS.
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Affiliation(s)
- Ron Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon & Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elsebeth Staun-Ram
- Multiple Sclerosis Center and Neuroimmunology Unit, Carmel Medical Center & Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dimitrios Karussis
- Unit for Neuroimmunology, Multiple Sclerosis and Cell Therapy, Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Arnon Karni
- Neuroimmunology and Multiple Sclerosis Unit, Tel Aviv Sourasky Medical Center & Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Mark A. Hellmann
- Department of Neurology, Rabin Medical Center & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Bar-Haim
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ariel Miller
- Multiple Sclerosis Center and Neuroimmunology Unit, Carmel Medical Center & Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Castaldo M, Waliszewska-Prosół M, Koutsokera M, Robotti M, Straburzyński M, Apostolakopoulou L, Capizzi M, Çibuku O, Ambat FDF, Frattale I, Gadzhieva Z, Gallo E, Gryglas-Dworak A, Halili G, Jusupova A, Koperskaya Y, Leheste AR, Manzo ML, Marcinnò A, Marino A, Mikulenka P, Ong BE, Polat B, Popovic Z, Rivera-Mancilla E, Roceanu AM, Rollo E, Romozzi M, Ruscitto C, Scotto di Clemente F, Strauss S, Taranta V, Terhart M, Tychenko I, Vigneri S, Misiak B, Martelletti P, Raggi A. Headache onset after vaccination against SARS-CoV-2: a systematic literature review and meta-analysis. J Headache Pain 2022; 23:41. [PMID: 35361131 PMCID: PMC8969402 DOI: 10.1186/s10194-022-01400-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features. Methods We searched PubMed and EMBASE covering the period between January 1st 2020 and August 6th, 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. “traditional” vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset. Results Out of 9338 records, 84 papers were included in the review, accounting for 1.57 million participants, 94% of whom received BNT162b2 or ChAdOx1. Headache was generally the third most common AE: it was detected in 22% (95% CI 18–27%) of subjects after the first dose of vaccine and in 29% (95% CI 23–35%) after the second, with an extreme heterogeneity. Those receiving placebo reported headache in 10–12% of cases. No differences were detected across different vaccines or by mRNA-based vs. “traditional” ones. None of the studies reported information on headache features. A lower prevalence of headache after the first injection of BNT162b2 among older participants was shown. Conclusions Our results show that vaccines are associated to a two-fold risk of developing headache within 7 days from injection, and the lack of difference between vaccine types enable to hypothesize that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction. Some descriptions report onset within the first 24 h and that in around one-third of the cases, headache has migraine-like features with pulsating quality, phono and photophobia; in 40–60% of the cases aggravation with activity is observed. The majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01400-4.
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Lupo-Stanghellini MT, Di Cosimo S, Costantini M, Monti S, Mantegazza R, Mantovani A, Salvarani C, Zinzani PL, Inglese M, Ciceri F, Apolone G, Ciliberto G, Baldanti F, Morrone A, Sinno V, Locatelli F, Notari S, Turola E, Giannarelli D, Silvestris N. mRNA-COVID19 Vaccination Can Be Considered Safe and Tolerable for Frail Patients. Front Oncol 2022; 12:855723. [PMID: 35371993 PMCID: PMC8969577 DOI: 10.3389/fonc.2022.855723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/21/2022] [Indexed: 01/04/2023] Open
Abstract
Background Frail patients are considered at relevant risk of complications due to coronavirus disease 2019 (COVID-19) infection and, for this reason, are prioritized candidates for vaccination. As these patients were originally not included in the registration trials, fear related to vaccine adverse events and disease worsening was one of the reasons for vaccine hesitancy. Herein, we report the safety profile of the prospective, multicenter, national VAX4FRAIL study (NCT04848493) to evaluate vaccines in a large trans-disease cohort of patients with solid or hematological malignancies and neurological and rheumatological diseases. Methods Between March 3 and September 2, 2021, 566 patients were evaluable for safety endpoint: 105 received the mRNA-1273 vaccine and 461 the BNT162b2 vaccine. Frail patients were defined per protocol as patients under treatment with hematological malignancies (n = 131), solid tumors (n = 191), immune-rheumatological diseases (n = 86), and neurological diseases (n = 158), including multiple sclerosis and generalized myasthenia. The impact of the vaccination on the health status of patients was assessed through a questionnaire focused on the first week after each vaccine dose. Results The most frequently reported moderate–severe adverse events were pain at the injection site (60.3% after the first dose, 55.4% after the second), fatigue (30.1%–41.7%), bone pain (27.4%–27.2%), and headache (11.8%–18.9%). Risk factors associated with the occurrence of severe symptoms after vaccine administration were identified through a multivariate logistic regression analysis: age was associated with severe fever presentation (younger patients vs. middle-aged vs. older ones), female individuals presented a higher probability of severe pain at the injection site, fatigue, headache, and bone pain; and the mRNA-1237 vaccine was associated with a higher probability of severe pain at the injection site and fever. After the first dose, patients presenting a severe symptom were at a relevant risk of recurrence of the same severe symptom after the second one. Overall, 11 patients (1.9%) after the first dose and 7 (1.2%) after the second one required postponement or suspension of the disease-specific treatment. Finally, two fatal events occurred among our 566 patients. These two events were considered unrelated to the vaccine. Conclusions Our study reports that mRNA-COVID-19 vaccination is safe also in frail patients; as expected, side effects were manageable and had a minimum impact on patient care path.
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Affiliation(s)
| | - Serena Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Sara Monti
- Department of Rheumatology, Policlinico San Matteo IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Renato Mantegazza
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Isitituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Mantovani
- Humanitas Scientific Directorate, IRCCS Humanitas, Clinical and Research Center, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
- William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Carlo Salvarani
- Unità di Reumatologia, Azienda unità sanitaria locale-IRCCS, Reggio Emilia, Italy
- Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Pier Luigi Zinzani
- Istituto di Ematologia “Seràgnoli” Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gennaro Ciliberto
- Scientific Directorate, IRCCS Regina Elena, National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Aldo Morrone
- Scientific Directorate, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Valentina Sinno
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
- Department of Gynecology-Obstetrics and Pediatrics, University “La Sapienza”, Roma, Italy
| | - Stefania Notari
- Cellular Immunology Laboratory, National Institute for Infectious Diseases L Spallanzani–IRCCS, Rome, Italy
| | - Elena Turola
- Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Istituto Nazionale Tumori Regina Elena IRCCS-IFO, Rome, Italy
| | - Nicola Silvestris
- Medical Oncology Department, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
- *Correspondence: Nicola Silvestris,
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Mariottini A, Bertozzi A, Marchi L, Di Cristinzi M, Mechi C, Barilaro A, Massacesi L, Repice AM. Effect of disease-modifying treatments on antibody-mediated response to anti-COVID19 vaccination in people with multiple sclerosis. J Neurol 2022; 269:2840-2847. [PMID: 35239006 PMCID: PMC8891428 DOI: 10.1007/s00415-022-11003-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 11/10/2022]
Abstract
Background Few data are available so far on the antibody-mediated immune response to anti-SARS-Cov2 vaccination in people with multiple sclerosis (pwMS) treated with disease-modifying treatments (DMTs), therefore this issue was explored in a real-life cohort of pwMS. Materials and methods Retrospective monocentric study on anti-spike protein antibody response in pwMS who had received vaccination for Sars-Cov2. Adverse events following vaccination were also recorded. Results One hundred and twenty pwMS were included: 83 females (69%); median age at vaccination 42 years (range 21–73); 112/120 patients (93%) were receiving DMTs at vaccination. Anti-spike protein IgG antibodies were detectable in 102/120 (85%) cases overall, being the proportion lower in pwMS receiving anti-CD20 antibodies (14/31, 45%) compared to non-depletive treatments (77/78, 99%), p < 0.0001. Median anti-spike titre was lower in anti-CD20 antibodies and fingolimod-treated pwMS compared to those receiving other DMTs, and it correlated with anti-CD20 treatment duration (R − 0.93, p < 0.0001) and with age at vaccination in pwMS not receiving depletive treatments (R − 0.25, p = 0.028). Baseline CD19+ cell count (where available) was higher in the responder group than in non-responders, p < 0.0001. Two symptomatic COVID-19 infections were diagnosed over a median follow-up of 5 months (range 2–7); adverse events were aligned with the published literature. Conclusion Antibody response to anti-COVID-19 vaccines was detected in most of the pwMS analysed, but frequency of responders was reduced in those receiving CD20 depleting therapies compared to other DMTs-treated pwMS. Investigations on cell-mediated immune response are needed to assess whether a protective immune response is elicited also in non-antibody responders.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.,Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Andrea Bertozzi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Leonardo Marchi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Maria Di Cristinzi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Claudia Mechi
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.,Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy.
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Soldà G, Barvas E, Lenzi J, Di Valerio Z, La Fauci G, Guttmann S, Riccardi R, Fantini MP, Salussolia A, Montalti M, Gori D. Gam-COVID-Vac (Sputnik V) and Pfizer-BioNTech Vaccines Adverse Events following Immunization in Patients Affected by Parkinson’s Disease and Multiple Sclerosis: A Longitudinal Study. Vaccines (Basel) 2022; 10:vaccines10030370. [PMID: 35335001 PMCID: PMC8953464 DOI: 10.3390/vaccines10030370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 01/27/2023] Open
Abstract
The Republic of San Marino COVID-19 vaccination campaign used Gam-COVID-Vac and Pfizer-BioNTech vaccines. To assess adverse events following immunization (AEFIs), approximately 6000 vaccine recipients were monitored by the ROCCA study, including subgroups with Parkinson’s Disease (PD) and Multiple Sclerosis (MS). The purpose of this study is to evaluate short-term AEFIs through a 1-month follow-up. We conducted a longitudinal study, using active surveillance to evaluate the safety profiles of COVID-19 vaccines in PD and MS patients. Participants were actively administered a standardized online questionnaire to collect information on AEFIs. Among all PD and MS assisted by the San Marino hospital, a total of 82 patients completed the questionnaires. One week after administration of the first dose, vaccine recipients reported AEFIs in 26% of cases in the PD group, 67% in the MS group, and 68% in the control group. Participants reported slightly higher rates of AEFIs after dose 2 compared with dose 1, being 29%, 75%, and 78% for PD, MS, control group, respectively. Most of the reported symptoms were mild. Patients with PD and MS reported few AEFIs after administration of the COVID-19 vaccines. The frequency of AEFIs in the PD population was significantly lower than in the control group.
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Affiliation(s)
- Giorgia Soldà
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (G.S.); (Z.D.V.); (A.S.); (M.M.)
| | - Edoardo Barvas
- San Marino Neurological Unit, State Hospital of the Republic of San Marino, 47893 Cailungo, San Marino; (E.B.); (S.G.)
| | - Jacopo Lenzi
- Unit of Hygiene, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (J.L.); (M.P.F.); (D.G.)
| | - Zeno Di Valerio
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (G.S.); (Z.D.V.); (A.S.); (M.M.)
| | - Giusy La Fauci
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (G.S.); (Z.D.V.); (A.S.); (M.M.)
- Correspondence: ; Tel.: +39-051-209-4802
| | - Susanna Guttmann
- San Marino Neurological Unit, State Hospital of the Republic of San Marino, 47893 Cailungo, San Marino; (E.B.); (S.G.)
| | - Rossano Riccardi
- San Marino Central Pharmacy, San Marino Hospital, 47893 Cailungo, San Marino;
| | - Maria Pia Fantini
- Unit of Hygiene, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (J.L.); (M.P.F.); (D.G.)
| | - Aurelia Salussolia
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (G.S.); (Z.D.V.); (A.S.); (M.M.)
| | - Marco Montalti
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (G.S.); (Z.D.V.); (A.S.); (M.M.)
| | - Davide Gori
- Unit of Hygiene, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, 40126 Bologna, Italy; (J.L.); (M.P.F.); (D.G.)
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Fragoso YD, Gomes S, Gonçalves MVM, Mendes Junior E, Oliveira BESD, Rocha CF, Santos GACD, Tauil CB, Araujo RV, Peron JPS. New relapse of multiple sclerosis and neuromyelitis optica as a potential adverse event of AstraZeneca AZD1222 vaccination for COVID-19. Mult Scler Relat Disord 2022; 57:103321. [PMID: 35158439 PMCID: PMC8511887 DOI: 10.1016/j.msard.2021.103321] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022]
Abstract
We report on nine patients (eight cases of MS and one case of NMOSD) who presented a disease relapse in close temporal association with their first AZD1222 vaccination dose against COVID-19. These patients had been stable for a median period of six years, with no evidence of disease activity and no change in their medication. After a median of 13 days (7 to 25 days) from vaccination, they developed a new relapse with increased disability and new lesions on magnetic resonance imaging. Although this association may be rare, it might be an adverse event of AZD1222.
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Affiliation(s)
- Yara D Fragoso
- Medical School, Universidade Metropolitana de Santos, UNIMES Avenida Conselheiro, Nebias 536, Santos, SP CEP 11045-002, Brazil.
| | - Sidney Gomes
- Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | | | | | | | | | | | - Jean Pierre S Peron
- Neuroimmune Interactions Laboratory, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Golshani M, Hrdý J. Multiple Sclerosis Patients and Disease Modifying Therapies: Impact on Immune Responses against COVID-19 and SARS-CoV-2 Vaccination. Vaccines (Basel) 2022; 10:vaccines10020279. [PMID: 35214735 PMCID: PMC8876554 DOI: 10.3390/vaccines10020279] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
This article reviews the literature on SARS-CoV-2 pandemic and multiple sclerosis (MS). The first part of the paper focuses on the current data on immunopathology of SARS-CoV-2 and leading vaccines produced against COVID-19 infection. In the second part of the article, we discuss the effect of Disease Modifying Therapies (DMTs) on COVID-19 infection severity or SARS-CoV-2 vaccination in MS patients plus safety profile of different vaccine platforms in MS patients.
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Affiliation(s)
| | - Jiří Hrdý
- Correspondence: ; Tel.: +420-224968509
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Toljan K, Amin M, Kunchok A, Ontaneda D. New diagnosis of multiple sclerosis in the setting of mRNA COVID-19 vaccine exposure. J Neuroimmunol 2022; 362:577785. [PMID: 34922126 PMCID: PMC8656147 DOI: 10.1016/j.jneuroim.2021.577785] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) with onset in the setting of acute SARS-CoV-2 virus infection has been reported, and reactivation of MS following non-mRNA COVID-19 vaccination has been noted, but there have only been three reports of newly diagnosed MS following exposure to mRNA COVID-19 vaccine. The association cannot be determined to be causal, as latent central nervous system demyelinating disease may unmask itself in the setting of an infection or a systemic inflammatory response. We report a series of 5 cases of newly diagnosed MS following recent exposure to mRNA COVID-19 vaccines. Latency from vaccination to initial presentation varied. Neurological manifestations and clinical course appeared to be typical for MS including response to high dose steroids in 4 cases and additional need for plasmapheresis in one case. CONCLUSION Acute neurological deficits in the setting of recent mRNA COVID-19 vaccine administration may represent new onset multiple sclerosis.
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Affiliation(s)
- Karlo Toljan
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Moein Amin
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Amy Kunchok
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
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Capone F, Lucchini M, Ferraro E, Bianco A, Rossi M, Cicia A, Cortese A, Cruciani A, De Arcangelis V, De Giglio L, Motolese F, Sancetta B, Mirabella M, Di Lazzaro V. Immunogenicity and safety of mRNA COVID-19 vaccines in people with multiple sclerosis treated with different disease-modifying therapies. Neurotherapeutics 2022; 19:325-333. [PMID: 34859382 PMCID: PMC8639214 DOI: 10.1007/s13311-021-01165-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/16/2022] Open
Abstract
The potential impact of disease-modifying therapies (DMTs) for multiple sclerosis (MS) on COVID-19 vaccination is poorly understood. According to recent observations, the humoral immune response could be impaired in patients treated with ocrelizumab or fingolimod. Our study evaluated the immunogenicity and safety of mRNA COVID-19 vaccines in a convenience sample of 140 MS patients treated with different DMTs, undergoing vaccination between April and June 2021. Humoral immune response was tested 1 month after the second dose, using a chemiluminescent microparticle immunoassay to detect IgG against SARS-CoV-2 nucleoprotein. We explored the potential correlation between the IgG titer and DMTs. All patients in treatment with first-line DMTs, natalizumab, cladribine, and alemtuzumab, developed a measurable humoral response. In patients treated with ocrelizumab and fingolimod, the IgG level was significantly lower, but only some patients (22.2% for fingolimod and 66% for ocrelizumab) failed to develop a measurable humoral response. In the ocrelizumab group, the IgG level was positively correlated with the time from last infusion. No SARS-CoV-2 infections were reported after vaccination. The most reported side effects were pain at the injection site (57.1%) and fatigue (37.9%). No patient experienced severe side effects requiring hospitalization. Our study confirms that COVID-19 vaccination is safe and well-tolerated in MS patients and should be recommended to all patients regardless of their current DMTs. Since fingolimod and ocrelizumab could reduce the humoral immune response, in patients treated with these drugs, detecting SARS-CoV-2 antibodies could be helpful to monitor the immune response after vaccination.
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Affiliation(s)
- Fioravante Capone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, 00128, Italy.
| | - Matteo Lucchini
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, CERSM, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Assunta Bianco
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, CERSM, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariagrazia Rossi
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, 00128, Italy
| | - Alessandra Cicia
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, CERSM, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Cortese
- Multiple Sclerosis Centre, S. Filippo Neri Hospital, Rome, Italy
| | - Alessandro Cruciani
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, 00128, Italy
| | - Valeria De Arcangelis
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura De Giglio
- Multiple Sclerosis Centre, S. Filippo Neri Hospital, Rome, Italy
| | - Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, 00128, Italy
| | - Biagio Sancetta
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, 00128, Italy
| | - Massimiliano Mirabella
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, CERSM, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, 00128, Italy
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Alonso R, Chertcoff A, Leguizamón FDV, Galleguillos Goiry L, Eizaguirre MB, Rodríguez R, Sosa M, Carballido S, Cruchet V, de Jong-Martis A, Giachello S, Henestroza P, Ferrandina F, Bauer J, Carrá A, Silva BA. Evaluation of short-term safety of COVID-19 vaccines in patients with multiple sclerosis from Latin America. Mult Scler J Exp Transl Clin 2021; 7:20552173211061543. [PMID: 34868630 PMCID: PMC8637726 DOI: 10.1177/20552173211061543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/03/2021] [Indexed: 01/11/2023] Open
Abstract
Background To date, there are no data available on the safety of COVID-19 vaccines in Latin American patients with Multiple Sclerosis (MS). Objective Characterize safety of COVID-19 vaccines in Latin American (LATAM) patients with Multiple Sclerosis (pwMS). Methods A cross-sectional study between February 1, 2021, and April 30, 2021. Individuals with MS from LATAM countries were invited to participate in a self-administered web-based survey, through MS patient organizations from the region. Results 393 vaccinated pwMS from 10 different Latin American countries were included. The vaccines administered were: inactivated virus vaccines (IVV) in 38.2% of patients, adenovirus vector vaccines (AdV) in 48.8% and mRNA vaccines 13%. All patients received at least one dose of any of the COVID-19 vaccines and 123 (31.3%) declared receiving a second dose. Mean (SD) age 41.5 (11.8) years, 82.4% female, MS disease duration: 8.4 (8.2) years. No serious adverse events were reported with any of the COVID-19 vaccines after either the first or second dose. A lower frequency of adverse events was found with IVV (22%) in comparison with AdV (46.4%) and mRNA (35.3%) (p < 0.01). Five participants reported having an MS relapse after IVV first dose. Conclusion COVID-19 vaccines applied in LATAM proved safe for MS patients.
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Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple - CUEM, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | | | | | - Maria B Eizaguirre
- Centro Universitario de Esclerosis Múltiple - CUEM, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Marta Sosa
- Renacer, Fundación Dominicana de EM, Santo Domingo, Dominican Republic
| | - Susana Carballido
- Asociación de Lucha contra la Esclerosis Múltiple de Colombia - ALEM, Medellín, Colombia
| | | | | | | | | | - Flavia Ferrandina
- Asociacion de Lucha contra la Esclerosis Múltiple - ALCEM, San Antonio de Padua, Argentina
| | - Johana Bauer
- Asociacion de Lucha contra la Esclerosis Múltiple - ALCEM, San Antonio de Padua, Argentina
| | - Adriana Carrá
- Esclerosis Múltiple Argentina - EMA, Buenos Aires, Argentina
| | - Berenice A Silva
- Centro Universitario de Esclerosis Múltiple - CUEM, Hospital Ramos Mejía, Buenos Aires, Argentina
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Briggs FBS, Mateen FJ, Schmidt H, Currie KM, Siefers HM, Crouthamel S, Bebo BF, Fiol J, Racke MK, O'Connor KC, Kolaczkowski LG, Klein P, Loud S, McBurney RN. COVID-19 Vaccination Reactogenicity in Persons With Multiple Sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 9:9/1/e1104. [PMID: 34753828 PMCID: PMC8579248 DOI: 10.1212/nxi.0000000000001104] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES There are limited data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine reactogenicity in persons with multiple sclerosis (PwMS) and how reactogenicity is affected by disease-modifying therapies (DMTs). The objective of this retrospective cross-sectional study was to generate real-world multiple sclerosis-specific vaccine safety information, particularly in the context of specific DMTs, and provide information to mitigate specific concerns in vaccine hesitant PwMS. METHODS Between 3/2021 and 6/2021, participants in iConquerMS, an online people-powered research network, reported SARS-CoV-2 vaccines, experiences of local (itch, pain, redness, swelling, or warmth at injection site) and systemic (fever, chills, fatigue, headache, joint pain, malaise, muscle ache, nausea, allergic, and other) reactions within 24 hours (none, mild, moderate, and severe), DMT use, and other attributes. Multivariable models characterized associations between clinical factors and reactogenicity. RESULTS In 719 PwMS, 64% reported experiencing a reaction after their first vaccination shot, and 17% reported a severe reaction. The most common reactions were pain at injection site (54%), fatigue (34%), headache (28%), and malaise (21%). Younger age, being female, prior SARS-CoV-2 infection, and receiving the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vs BNT162b2 (Pfizer-BioNTech) vaccine were associated with experiencing a reaction after the first vaccine dose. Similar relationships were observed for a severe reaction, including higher odds of reactions among PwMS with more physical impairment and lower odds of reactions for PwMS on an alpha4-integrin blocker or sphingosine-1-phosphate receptor modulator. In 442 PwMS who received their second vaccination shot, 74% reported experiencing a reaction, whereas 22% reported a severe reaction. Reaction profiles after the second shot were similar to those reported after the first shot. Younger PwMS and those who received the mRNA-1273 (Moderna) vs BNT162b2 vaccine reported higher reactogenicity after the second shot, whereas those on a sphingosine-1-phosphate receptor modulator or fumarate were significantly less likely to report a reaction. DISCUSSION SARS-CoV-2 vaccine reactogenicity profiles and the associated factors in this convenience sample of PwMS appear similar to those reported in the general population. PwMS on specific DMTs were less likely to report vaccine reactions. Overall, the short-term vaccine reactions experienced in the study population were mostly self-limiting, including pain at the injection site, fatigue, headache, and fever.
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Affiliation(s)
- Farren Basil Shaw Briggs
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA.
| | - Farrah J Mateen
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Hollie Schmidt
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Keisha M Currie
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Heather M Siefers
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Slavka Crouthamel
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Bruce F Bebo
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Julie Fiol
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Michael K Racke
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Kevin C O'Connor
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Laura G Kolaczkowski
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Phyllis Klein
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Sara Loud
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
| | - Robert Nicholas McBurney
- From the Department of Population and Quantitative Health Science (F.B.S.B.), School of Medicine, Cleveland, OH; Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Accelerated Cure Project for MS (H.S., S.L., R.N.M.), Waltham, MA; Currie Consultancy (K.M.C.), LLC Eastover, SC; International AIDS Vaccine Initiative (H.M.S.), Frederick, MD; Mammoth Hospital (S.C.), Mammoth Lakes, CA; National Multiple Sclerosis Society (B.F.B., J.F.); Medical Affairs (M.K.R.), Quest Diagnostics, Secaucus, NJ; Departments of Neurology and Immunobiology (K.C.O.), Yale University School of Medicine, New Haven, CT; and iConquerMS (L.G.K., P.K.), Waltham, MA
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Bellucci G, Rinaldi V, Buscarinu MC, Reniè R, Bigi R, Pellicciari G, Morena E, Romano C, Marrone A, Mechelli R, Salvetti M, Ristori G. Multiple Sclerosis and SARS-CoV-2: Has the Interplay Started? Front Immunol 2021; 12:755333. [PMID: 34646278 PMCID: PMC8503550 DOI: 10.3389/fimmu.2021.755333] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 12/11/2022] Open
Abstract
Current knowledge on Multiple Sclerosis (MS) etiopathogenesis encompasses complex interactions between the host's genetic background and several environmental factors that result in dysimmunity against the central nervous system. An old-aged association exists between MS and viral infections, capable of triggering and sustaining neuroinflammation through direct and indirect mechanisms. The novel Coronavirus, SARS-CoV-2, has a remarkable, and still not fully understood, impact on the immune system: the occurrence and severity of both acute COVID-19 and post-infectious chronic illness (long COVID-19) largely depends on the host's response to the infection, that echoes several aspects of MS pathobiology. Furthermore, other MS-associated viruses, such as the Epstein-Barr Virus (EBV) and Human Endogenous Retroviruses (HERVs), may enhance a mechanistic interplay with the novel Coronavirus, with the potential to interfere in MS natural history. Studies on COVID-19 in people with MS have helped clinicians in adjusting therapeutic strategies during the pandemic; similar efforts are being made for SARS-CoV-2 vaccination campaigns. In this Review, we look over 18 months of SARS-CoV-2 pandemic from the perspective of MS: we dissect neuroinflammatory and demyelinating mechanisms associated with COVID-19, summarize pathophysiological crossroads between MS and SARS-CoV-2 infection, and discuss present evidence on COVID-19 and its vaccination in people with MS.
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Affiliation(s)
- Gianmarco Bellucci
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Virginia Rinaldi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Roberta Reniè
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Rachele Bigi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Giulia Pellicciari
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Emanuele Morena
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Carmela Romano
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Antonio Marrone
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana, Rome, Italy
- San Raffaele Roma Open University, Rome, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
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50
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Azimzadeh M, Möhn N, Ghane Ezabadi S, Moghimi Esfandabadi Z, Soleimani A, Ranjbar E, Jahromi M, Seyedebrahimi R, Skripuletz T, Moharrami Kasmaie F. The Immunological Therapeutic Strategies for Controlling Multiple Sclerosis: Considerations during the COVID-19 Pandemic. Biomolecules 2021; 11:1372. [PMID: 34572585 PMCID: PMC8470206 DOI: 10.3390/biom11091372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
A growing body of evidence initially suggested that patients with multiple sclerosis (MS) might be more susceptible to coronavirus disease 2019 (COVID-19). Moreover, it was speculated that patients with MS treated with immunosuppressive drugs might be at risk to develop a severe diseases course after infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2). However, the recently published data have shown that MS patients do not have a higher risk for severe COVID-19. Although there is no indication that patients with MS and immunomodulatory/immunosuppressive therapy are generally at a higher risk of severe COVID-19, it is currently being emphasized that the hazards of poorly treated MS may outweigh the putative COVID-19 dangers. In this review, we discuss the challenges and considerations for MS patients in the COVID-19 pandemic.
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Affiliation(s)
- Maryam Azimzadeh
- Department of Medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran;
| | - Nora Möhn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Sajjad Ghane Ezabadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran;
| | | | - Alireza Soleimani
- Department of Medical Laboratory Sciences, Faculty of Paramedicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
| | - Elaheh Ranjbar
- Department of Paramedical Sciences, Gonabad University of Medical Sciences, Gonabad, Iran;
| | - Maliheh Jahromi
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran;
| | - Reihaneh Seyedebrahimi
- Department of Anatomical Sciences, School of Medicine, Qom University of Medical Sciences, Qom, Iran;
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Farshad Moharrami Kasmaie
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
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