Serological response to SARS-CoV-2 vaccination in multiple sclerosis patient in a real-life experience

Introduction: Vaccination against COVID-19 has been widely recommended for patients with multiple sclerosis (MS), although the effect of different disease-modifying treatments (DMTs) on said immunization is not well known. Some studies begin to point out a relationship between DMTs of greater efficacy with a lower rate of seroprotection. Objectives: To assess serological response to SARS-CoV-2 vaccination in MS patients receiving disease-modifying treatments (DMTs) in a real-life setting. Methods: Anti-spike protein-based serology was measured in 191 patients with MS and 6 patients with neuromyelitis optica spectrum disorder (NMOSD). Patients were either untreated or under treatment with different DMTs. A group of healthy subjects similarly vaccinated served as control. The percent of subjects that developed protective antibodies, the antibody-titer, and lymphocyte counts were evaluated. Results: Patients and controls were vaccinated with different available vaccines: BNT162b2 (68.6%), mRNA-1273 (5.4%), ChAdOx1-S (20.7%) and Ad26COVS1 (4.3%). Protective serological response was observed in 100% of controls, NMOSD, untreated (n=19), Interferon-beta (n=17), Glatiramer-acetate (n=15), Cladribine (n=11), Dimethyl-fumarate (n=15), Teriflunomide (n=29) and Natalizumab (n=25) patients. 100% was also observed in Alemtuzumab (n=11) patients but none received treatment dose in last year. Serological response was observed in 42%, 44% and 0% of Fingolimod (n=12), Ocrelizumab (n=26) and Rituximab (n=6) patients respectively. Time from the last dosing was related to serological response in anti-CD-20 therapies;age, disease duration, disease phenotype, vaccine used, or lymphocyte counts did not affect humoral response to COVID-19 vaccination. Conclusions: Anti-CD20 therapies and Fingolimod seem to condition a lower humoral response to vaccines against SARS-CoV-2. Vaccination prior initiation of these DMTs medication administration would be recommendable whenever possible.

13th Post-ECTRIMS Meeting: review of the new developments presented at the 2020 ECTRIMS Congress (I). / XIII Reunión Post-ECTRIMS: revisión de las novedades presentadas en el Congreso ECTRIMS 2020 (I).

INTRODUCTION: For more than a decade, following the ECTRIMS Congress, the Post-ECTRIMS Meeting has been held in Spain, where neurologists with expertise in multiple sclerosis (MS) from all over the country meet to review the most relevant latest developments presented at the ECTRIMS congress (on this occasion held together with ACTRIMS). AIM: This article, published in two parts, summarises the presentations that took place at the Post-ECTRIMS Meeting, held online on 16 and 17 October 2020. DEVELOPMENT: This first part includes the latest results regarding the impact of the environment and lifestyle on risk of MS and its clinical course, and the role of epigenetics and genetic factors on these processes. Findings from preclinical and clinical research on the lymphocyte subtypes identified and the involvement of lymphoid follicles and meningeal involvement in the disease are discussed. Changes in brain structure are addressed at the microscopic and macroscopic levels, including results from high-resolution imaging techniques. The latest advances on biomarkers for the diagnosis and prognosis of MS, and on the involvement of the microbiome in these patients are also reported. Finally, results from patient registries on the impact of COVID-19 in MS patients are outlined. CONCLUSIONS: There have been new data on MS risk factors, the impact of MS at the cellular and structural level, the role of the microbiome in the disease, biomarkers, and the relationship between COVID-19 and MS.

TITLE: XIII Reunión Post-ECTRIMS: revisión de las novedades presentadas en el Congreso ECTRIMS 2020 (I).Introducción. Desde hace más de una década, tras el congreso ECTRIMS, se celebra en España la reunión Post-ECTRIMS, donde neurólogos expertos en esclerosis múltiple (EM) de toda España se reúnen para revisar las principales novedades presentadas en el ECTRIMS (en esta ocasión, celebrado junto con el ACTRIMS). Objetivo. En el presente artículo, publicado en dos partes, se resumen las ponencias que tuvieron lugar en la reunión Post-ECTRIMS, celebrada los días 16 y 17 de octubre de 2020 de forma virtual. Desarrollo. En esta primera parte se incluyen los últimos resultados acerca del impacto del ambiente y el estilo de vida sobre el riesgo de EM y su curso clínico, y el papel de la epigenética y los factores genéticos sobre estos procesos. Se discuten los hallazgos en investigación preclínica y clínica sobre los subtipos de linfocitos identificados, y la implicación de los folículos linfoides y la afectación meníngea en la enfermedad. Los cambios en la estructura cerebral se abordan a nivel microscópico y macroscópico, incluyendo resultados de técnicas de imagen de alta resolución. También se presentan los últimos avances sobre biomarcadores para el diagnóstico y el pronóstico de la EM, y sobre la afectación del microbioma en estos pacientes. Por último, se esbozan los resultados de registros de pacientes sobre el impacto de la COVID-19 en los pacientes con EM. Conclusiones. Ha habido nuevos datos sobre factores de riesgo de la EM, impacto de la EM a nivel celular y estructural, papel del microbioma en la enfermedad, biomarcadores y la relación entre COVID-19 y EM.

Pulse immunosuppressive therapy for multiple sclerosis during the SARS-CoV-2 lockdown de-escalation plan: Safety algorithm. / Tratamiento inmunosupresor en pulsos en esclerosis múltiple durante el desescalado de la epidemia por SARS-CoV-2. Algoritmo de seguridad.

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.