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. 2022 Jan;91(1):89-100.
doi: 10.1002/ana.26251. Epub 2021 Nov 17.

COVID-19 Vaccine Response in People with Multiple Sclerosis

Emma C Tallantyre #  1   2 , Nicola Vickaryous #  3 , Valerie Anderson  1 , Aliye Nazli Asardag  4 , David Baker  4 , Jonathan Bestwick  3 , Kath Bramhall  5 , Randy Chance  4   6 , Nikos Evangelou  7 , Katila George  3 , Gavin Giovannoni  3   4   8 , Andrew Godkin  9   10 , Leanne Grant  5 , Katharine E Harding  11 , Aimee Hibbert  7 , Gillian Ingram  12 , Meleri Jones  4 , Angray S Kang  4   6 , Samantha Loveless  1 , Stuart J Moat  13   14 , Neil P Robertson  1   2 , Klaus Schmierer  4   8 , Martin J Scurr  9   15 , Sita Navin Shah  3 , Jessica Simmons  1 , Matthew Upcott  1 , Mark Willis  2 , Stephen Jolles #  5   9 , Ruth Dobson #  3   8
Affiliations

COVID-19 Vaccine Response in People with Multiple Sclerosis

Emma C Tallantyre et al. Ann Neurol. 2022 Jan.

Abstract

Objective: The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines in people with multiple sclerosis (MS).

Methods: Four hundred seventy-three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (COVID-19) and vaccine history, medical, and drug history were extracted from questionnaires and medical records. Dried blood spots were eluted and tested for antibodies to SARS-CoV-2. Antibody titers were partitioned into tertiles with people on no disease modifying therapy as a reference. We calculated the odds ratio of seroconversion (univariate logistic regression) and compared quantitative vaccine response (Kruskal Wallis) following the SARS-CoV-2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response.

Results: Compared to no disease modifying therapy, the use of anti-CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01-0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01-0.12) were associated with lower seroconversion following the SARS-CoV-2 vaccine. All other drugs did not differ significantly from the untreated cohort. Both time since last anti-CD20 treatment and total time on treatment were significantly associated with the response to the vaccination. The vaccine type significantly predicted seroconversion, but not in those on anti-CD20 medications. Preliminary data on cellular T-cell immunity showed 40% of seronegative subjects had measurable anti-SARS-CoV-2 T cell responses.

Interpretation: Some disease modifying therapies convey risk of attenuated serological response to SARS-CoV-2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a-n/a.

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Conflict of interest statement

Biogen, Merck, Novartis, Roche, Sanofi/Genzyme, and Teva all manufacture multiple sclerosis disease modifying therapies that were used in this study, or which could be affected by the study. The following authors have received speaker fees, consultancy fees, and/ or travel expenses to attend educational meetings from one or more of these companies: E.C.T., D.B., R.D., N.E., G.G., A.K., N.P.R., K.S., S.J., M.J.S., and A.G. are co‐founders of and holds equity in ImmunoServ Ltd., which provided T‐cell analysis. N.V., V.A., A.N.A., J.B., K.B., R.C., K.G., L.G., A.G., K.E.H., A.H., G.I., M.J., A.S.K., S.L., S.J.M., S.N.S., J.S., M.U., and M.W. have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flow chart illustrating recruitment and selection of the study cohort.
FIGURE 2
FIGURE 2
Violin plot illustrating anti‐SARS‐CoV‐2 antibody response following complete COVID‐19 vaccine course, according to DMT. The plot shows distribution of results according to tertiles, using the “no DMT” group as a reference. Circle indicates median, bold line indicates interquartile range. (A) All samples (B) seropositive samples only. COVID‐19 = coronavirus disease 2019; DMT = disease modifying therapy; SARS‐CoV‐2 = severe acute respiratory syndrome‐coronavirus 2. [Color figure can be viewed at www.annalsofneurology.org]
FIGURE 3
FIGURE 3
Violin plot illustrating anti‐SARS‐CoV2 antibody response following complete COVID‐19 vaccine course, according to vaccine type. The plot shows distribution of results according to tertiles, using the “no DMT” group as a reference. The circle indicates median, and the bold line indicates interquartile range. Astra Zeneca: ChAdOx1 nCoV‐19 (Oxford–AstraZeneca), Pfizer: BNT162b2 mRNA (Pfizer‐BioNTech) vaccine. (a) People who had received anti‐CD20 monoclonal antibodies. (b) All other DMT (fingolimod excluded). COVID‐19 = coronavirus disease 2019; DMT = disease modifying therapy; nCov = novel coronavirus; SARS‐CoV‐2 = severe acute respiratory syndrome‐coronavirus 2. [Color figure can be viewed at www.annalsofneurology.org]
See this image and copyright information in PMC

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