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Observational Study
. 2023 Aug;30(8):2357-2364.
doi: 10.1111/ene.15830. Epub 2023 May 28.

Antibody response elicited by the SARS-CoV-2 vaccine booster in patients with multiple sclerosis: Who gains from it?

Irene Schiavetti  1 , Matilde Inglese  2   3 , Jessica Frau  4 , Elisabetta Signoriello  5 , Francesca Caleri  6 , Maria Laura Stromillo  7 , Maria Teresa Ferrò  8 , Maria Teresa Rilla  9 , Ilaria Gandoglia  10 , Paola Gazzola  11 , Giampaolo Brichetto  12 , Livia Pasquali  13 , Luigi Grimaldi  14 , Monica Ulivelli  15 , Fabiana Marinelli  16 , Susanna Cordera  17 , Marinella Clerico  18 , Antonella Conte  19   20 , Marco Salvetti  20   21 , Mario Alberto Battaglia  22   23 , Diego Franciotta  24 , Antonio Uccelli  2   3 , Maria Pia Sormani  1   2 ; CovaXiMS Study Group
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Free article
Observational Study

Antibody response elicited by the SARS-CoV-2 vaccine booster in patients with multiple sclerosis: Who gains from it?

Irene Schiavetti et al. Eur J Neurol. 2023 Aug.
Free article

Abstract

Background and purpose: Although two doses of COVID-19 vaccine elicited a protective humoral response in most persons with multiple sclerosis (pwMS), a significant group of them treated with immunosuppressive disease-modifying therapies (DMTs) showed less efficient responses.

Methods: This prospective multicenter observational study evaluates differences in immune response after a third vaccine dose in pwMS.

Results: Four hundred seventy-three pwMS were analyzed. Compared to untreated patients, there was a 50-fold decrease (95% confidence interval [CI] = 14.3-100.0, p < 0.001) in serum SARS-CoV-2 antibody levels in those on rituximab, a 20-fold decrease (95% CI = 8.3-50.0, p < 0.001) in those on ocrelizumab, and a 2.3-fold decrease (95% CI = 1.2-4.6, p = 0.015) in those on fingolimod. As compared to the antibody levels after the second vaccine dose, patients on the anti-CD20 drugs rituximab and ocrelizumab showed a 2.3-fold lower gain (95% CI = 1.4-3.8, p = 0.001), whereas those on fingolimod showed a 1.7-fold higher gain (95% CI = 1.1-2.7, p = 0.012), compared to patients treated with other DMTs.

Conclusions: All pwMS increased their serum SARS-CoV-2 antibody levels after the third vaccine dose. The mean antibody values of patients treated with ocrelizumab/rituximab remained well below the empirical "protective threshold" for risk of infection identified in the CovaXiMS study (>659 binding antibody units/mL), whereas for patients treated with fingolimod this value was significantly closer to the cutoff.

Keywords: COVID-19; SARS-CoV-2 vaccine; anti-CD20; booster dose; fingolimod; multiple sclerosis.

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References

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