ABSTRACT
Introduction: In this study we aimed to monitor the risk of breakthrough COVID-19 infection in pwMS on different Disease Modifying Therapies (DMT) included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with and vaccinated against COVID-19. Method(s): retrospective cohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Specific information was requested (vaccine received, dose, date, symptoms, COVID- 19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 857 pwMS patients from eight countries in LATAM were included. Mean age was 44.3 +/-12 years. The most frequent treatment used was fingolimod in 171 (19.9%). Most frequent first and second dose received was Astra-Zeneca (33%). During follow-up, a total of 28 COVID-19 cases were observed for a total exposure time of 150.965 days. The overall cumulative incidence was 3.2% (SE 0.22%) with an overall incidence density (ID) of 1.8 x 10.000 patients/day (95%CI 0.2-3.2). Compared to other DMTs, the incidence rate of breakthrough infections was significantly higher on ocrelizumab (6.02 (95%CI=5.65-7.16, RR=5.17 95%CI 3.27-7.12) and rituximab (6.94 (95%CI=6.15-9.12, RR= 5.93 95%CI 3.55-7.32) compared with other DMTs. No significant differences in the risk of breakthrough were observed for vaccine subtypes. Conclusion(s): An increased risk of breakthrough COVID-19 infections was observed in patients treated with ocrelizumab and rituximab.
ABSTRACT
Background: B cells are responsible for the synthesis of antibodies in people who receive SARS-CoV-2 vaccines. In multiple sclerosis (MS), the seroconversion rate after SARS-CoV-2 vaccine may be influenced by disease-modifying therapies (DMTs) specially by anti-CD20 therapies. Objective(s): To investigate the seroprevalence and the quantity of SARS-CoV-2 antibodies in a cohort of patients with MS. Method(s): It is a retrospective study in which we included MS patients treated with DMTs who were vaccinated against SARSCoV- 2 between February 18 - August 4, 2021.A blood collection at 4 weeks after the second dose was planned. Statistical analysis was performed using SPSS version 24. Significant statistical differences between variables were determined using the U Mann Whitney and chi squared tests. Result(s): A total of 43 MS patients were included in the study, the age range was 23-68. Sixty-nine percent (31/43) of the patients demonstrated a humoral response. Stratified by DMT type, patients treated with interferon yielded 100% measurable antibodies;62% of the MS patients developed antibodies following vaccination with fingolimod. Finally, only 43% of MS patients with anti-CD20 therapies developed a humoral response (p=0.03). The mean of SARSCoV- 2 antibodies in MS patients with anti-CD20 therapies were lower in comparison with patients treated with interferons and fingolimod (61,9 UI/ml vs 546,5 Ul/ml vs 263,4 Ul/ml) p<0.001. Conclusion(s): MS patients are able to mount a humoral vaccine response to SARS-CoV-2, irrespective of the vaccine type administered;patients treated with fingolimod and anti-CD20 agents are least likely to mount such a response in comparison with MS patients treated with interferon.
ABSTRACT
Objective: The objective of the study was to evaluate the incidence of COVID-19 infections after vaccination in NMOSD patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected and vaccinated for COVID-19. Method(s): Retrospective cohort study developed between May 2021 to December 2021. The primary outcome was the appearance of infection during the follow up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (vaccine received, dose, date, symptoms, COVID-19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 19 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 49 NMOSD patients from eight countries in LATAM were included. Mean age was 43.8 +/-13 years. The most frequent treatment use was rituximab in 29 (59.2%). The mean follow up after the second dose was 149 +/- 32 days. Most frequent first and second dose received was Pfizer (28.6%), followed by Sinopharm (24.5%). During follow up a total of 2 COVID-19 cases were observed for a total exposure time of 8627 days. Cumulative incidence was 4.1% (SE 0.87%) with an overall incidence density of 2.31 x 10.000 patients/day (95%CI 1.13-3.71). Both cases occurred in patients under rituximab (2/29, exposure time 4208, IR 4.7 x 10,000 patients/day 95%CI 3.5-5.1). No hospitalizations were reported for both cases. Conclusion(s): We observed an ID of COVID-19 infection after vaccination of 2.31 x 10.000 patients/day in NMOSD patients.