How Do Vaccinated MS Patients Fare with COVID-19 Antibodies?
Which disease-modifying drugs for the treatment of multiple sclerosis (MS) reduce the humoral response to COVID-19 vaccination? And does the quantity of post-vaccination antibodies vary depending on the specific vaccine?
DMDs and Humoral Response
The first studies addressing the humoral response to COVID-19 vaccination indicate reduced antibody production in multiple sclerosis patients treated with certain disease-modifying drugs (DMDs). This is particularly true for DMDs targeting the CD20 molecule (ocrelizumab, rituximab) and fingolimod. Italian authors of a study published in October this year also examined the significance of the specific type of mRNA vaccine, aside from the impact of DMDs. Was any particular vaccine able to significantly increase the amount of antibodies?
Methodology and Study Progress
This prospective multicenter study included MS patients scheduled to receive an mRNA vaccine against COVID-19 (BNT162b2 /Comirnaty/ from Pfizer/BioNTech or mRNA-1273 /Spikevax/ from Moderna). Blood samples to determine the amount of SARS-CoV-2 IgG antibodies were taken before the first vaccine dose and again 4 weeks after the second dose.
Results
A total of 780 patients were included in the study, 11.2% of whom were not on DMD therapy, 19.7% were on ocrelizumab, 3.2% on rituximab, 10.9% on fingolimod, 3.2% on cladribine, and 51.7% on another DMD. In total, 76% of participants received the BNT162b2 mRNA vaccine, while 24% received the mRNA-1273. Detectable post-vaccination antibody levels against the SARS-CoV-2 virus were found in 86.8% of the patients.
Multivariate analysis confirmed significantly lower post-vaccination antibody levels in patients on ocrelizumab (201×), fingolimod (26×), and rituximab (20×) therapy compared to patients not treated with DMDs. Antibody levels against SARS-CoV-2 in patients on CD20-targeting DMDs (ocrelizumab, rituximab) positively correlated with the time since the last drug infusion before vaccination. Patients vaccinated with the mRNA-1273 demonstrated 3.25× higher antibody production (95% confidence interval [CI] 2.46–4.27) compared to those vaccinated with BNT162b2 (p < 0.001).
Conclusion
Therapy with CD20-targeting DMDs and fingolimod led to a predictably lower humoral response to SARS-CoV-2 vaccination. However, patients vaccinated with the mRNA-1273 developed 3.25× higher antibody levels compared to those who received the BNT162b2 vaccine. The Moderna vaccine might thus be preferred for patients on DMDs that reduce the humoral response to the vaccine. To determine the most effective vaccination strategy in this patient population, it is necessary to combine the presented data with insights into post-vaccination cellular immune response and clinical monitoring of the vaccinated patients.
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Source: Sormani M. P., Inglese M., Schiavetti I. et al. Effect of SARS-CoV-2 mRNA vaccination in MS patients treated with disease modifying therapies. EBioMedicine 2021 Oct; 72: 103581, doi: 10.1016/j.ebiom.2021.103581.
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