ABSTRACT
Introduction: The role of ongoing disease-modifying therapy (DMT) in coronavirus disease 2019 (Covid-19) morbidity and mortality in people with multiple sclerosis (MS, pwMS) is uncertain. The MS International Federation recommends that pwMS continue their medication. Objective(s): To investigate the relationship between DMT used in MS patients and the risk of Covid-19 infection. Aim(s): The MS cohort of 3402 people followed for Covid-19 infection was included in this longitudinal cohort study. The whole MS cohort was interviewed at least once for information about Covid- 19, by text message, or by phone, during which 487 pwMS were determined with Covid-19 infection. A semi-structured interview, which included questions related to COVID-19 symptoms, recovery status, and duration of symptoms, was developed and performed by a team consisting medical doctor, nurse, and physiotherapist. Clinical information was obtained from the patient's medical records. Result(s): Of the 487 pwMS infected with Covid-19, 35 reported reinfections. The clinical and demographic profiles of participants were following: the mean age was 40.3+/-11.4, the mean disease duration was 10.7+/-8.2, the mean EDSS score was 1.7+/-2, 342 (70.2%) were female, 425 (87.3%) had relapsing-remitting MS, and 324 (6.5%) were working. The major differences regarding DMT between pwMS with and without Covid-19 infection were observed for fingolimod, ocrelizumab, and azathioprine. Fortythree (8.9%) people experienced the Covid-19 infection severely or critically;of those, 15 (34.9%) had MS treatment with ocrelizumab. Thirty-two (6.6%) patients reported that they were hospitalized;12 (37.5%) of these had been treated for MS with ocrelizumab. Fifty percent of pwMS who were treated in intensive care (7/14 patients) and died (3/6 patients) were being treated with ocrelizumab. As a result of the regression analysis, any additional risk factor on Covid-19 related to MS treatments was not detected, while working/being active in social life has a risk factor on the Covid-19 infection and it is course. Conclusion(s): The current data show that pwMS using ocrelizumab have a more severe course of Covid-19 infection than those using other DMTs. These data will guide the treatment of pwMS in cases of new Covid-19 variants or similar pandemic situations that may develop in the future.
ABSTRACT
Introduciton: Multiple Sclerosis (MS) is an autoimmune disease with B-cell dysregulation playing an essential role in pathogenesis. As B-cells are also responsible for antibody production, their disfunction could also affect the humoral immune response against SARS-CoV-2 vaccines. Aim(s): To compare the immune response after messenger RNA (mRNA) BNT162b2 (Pfizer/BioNTech) and inactivated Coronavac vaccines in newly diagnosed treatment-naive MS (tnMS) patients and healthy controls (HC). Method(s): A single-center cross-sectional study evaluating antibody response against SARS-CoV-2 vaccines (inactivated vs mRNA) in HC and newly diagnosed and treatment-naive MS patients. Serum samples were collected at least two weeks after the second dose of the vaccine. The cutoff level of seropositivity is >= 50 antibody unit (AU)/ml. Result(s): 46 participants had two doses of inactivated Coronavac (35 HC and 11 tnMS), and 103 (57 HC and 46 tnMS) had two doses of mRNA. There was no significant difference in antibody response between HC and tnMS in the inactivated vaccine group. In the mRNA group, the antibody titers were significantly higher in HC (p=0.009), though no difference in the seropositivity rates was observed. Conclusion(s): Although MS is an autoimmune inflammatory disease, it does not affect immunity against the SARS-CoV-2 vaccine in treatment-naive patients.
ABSTRACT
Introduction: Disease-modifying therapy (DMT) may decrease the immune response to COVID-19 vaccines, and the antibody response against SARS- CoV-2 is still not fully explored in people with multiple sclerosis(pwMS). Aim(s): To evaluate the immune response after messenger RNA (mRNA) BNT162b2 (Pfizer/BioNTech) and inactivated Coronavac vaccines in pwMS treated with a DMT compared to healthy controls(HC). Method(s): Patients who came to our MS unit for treatment or routine control were included in the study. Serum samples were collected at least two weeks after the second dose of the vaccine. The cutoff level or seropositivity is >= 50 antibody units (AU)/ml. The antibody titers were compared between HC and each treatment group. Result(s): 815 pwMS treated with DMT, 90 untreated MS patients and 92 healthy controls were enrolled in this single-center crosssectional study. In total, 500 (50.2%) participants received two doses of inactivated Coronavac, and 497(49.8%) received two doses of BNT162b2. In HC group, only one patient who had mRNA vaccine was seronegative. All patients on cladribine (n =14, 100%)and azathioprine (n=5) treatment have seropositive results in both vaccine types. Among treatment groups, fingolimod and ocrelizumab were associated with lower antibody titers (p<0.005). Only in fingolimod group, seropositivity rate was higher for mRNA vaccine compared to inactivated vaccine. The SARS CoV-2 antibody titer was significantly associated with mRNA vaccine [beta= 0.739 (0.067) 95%CI= 0.607;-0.870 p<0.001], EDSS [beta= -0.061 (0.024) 95%CI= -0.108;-0.013 p<0.012], time between second vaccine dose and sample collection dates [beta=-0.002 (0.001) 95%CI= -0.003;-0.001 p<0.001] and relapsing MS type [beta= -0.395 (0.136) 95%CI= -0.662;-0.127 p<0.004] Conclusion(s): Fingolimod and ocrelizumab therapy are associated with decreased immunity after SARS CoV2 vaccines. mRNA type of vaccine is the preferable choice in pwMS.
ABSTRACT
Introduction: There is concern that people with neuromyelitis optica spectrum disorder (NMOSD, pwNMOSD) may be defenseless to developing coronavirus disease 2019 (Covid-19) due to immunosuppressive therapy. Moreover, there is limited information prognosis of Covid-19 in NMOSD. Aim(s): The study aims to investigate the relationship between the demographic, clinical, and therapeutic characteristics of the NMOSD cohort and the outcome of Covid-19 infection and compare it with the general population. Method(s): The whole NMOSD cohort, consisting of 90 people followed up at the Dokuz Eylul University Hospital, was interviewed at least once, face-to-face, via text message, or by phone, and the participants were questioned whether they were infected with Covid-19. The Covid-19 infection was detected in 19 pwNMOSD. A semi-structured phone interview consisting of 34 questions was done with all patients infected with Covid-19 infection, and detailed information about the Covid-19 infection course was obtained. Clinical information was obtained from the patient's medical records. Result(s): We identified 16 confirmed and three suspected (not confirmed with real-time PCR) pwNMOSD who had experienced Covid-19 infections. Three pwNMOSD have reinfection with Covid-19. The mean (SD) age, body mass index, disease duration, and Expanded Disability Status Scale score were 43.5 (13.9), 26.3 (5.3), 6 (6.6), and 2.5 (2), respectively. Of pwNMOSD, 17 (89.5%) were female, 12 (63.2%) were working. None of the participants reported smoking. Covid-19 cases (21.1%) were 1.4 times more common in our NMOSD population than in the general population (16.6%). The rate of Covid-19 infection course was the following: 3 (15.8%) people experienced severe, 1 (5.3%) people reported pneumonia which was treated in hospital, 16 (84.2%) people experienced mild, and no pwNMOSD died due to Covid- 19 infection. The most common reported symptoms were fever, cough, weakness, and musculoskeletal pain. The major differences were observed for rituximab between pwNMOSD with and without Covid-19 infection. Conclusion(s): Our results indicated that pwNMOSD appear to be at higher risk of contracting Covid-19 than the general population. However, most people with pwNMOSD recover mildly from the Covid-19 infection. Available data show that there is no need for additional concern for people with pwNMOSD in a similar pandemic that may develop in the future.
ABSTRACT
Introduction/Objectives: Immunity after two doses of inactivated and messenger RNA(mRNA) SARS-CoV 2 vaccines in Multiple Sclerosis (MS) is influenced by the Disease-Modifying Therapy (DMT) and vaccine type used. Being lower in fingolimod, ocrelizumab, and inactivated vaccine groups. A booster dose could change this discrepancy. Aim(s): To compare the immunogenicity of a booster dose of mRNA BNT162b2 (Pfizer/BioNTech) versus inactivated vaccine, performed after completing two doses of inactivated Coronavac in people with MS (pwMS). Method(s): pwMS and Healthy Controls (HC) who received a booster dose of SARS-CoV 2 mRNA or inactivated vaccine after completing two doses of inactivated Coronovac were enrolled in this single-center cross-sectional study. Serum samples were collected at least two weeks after the third dose of the vaccine. The antibody titers were compared between HC, MS, and each treatment group. Result(s): Each of 339 pwMS and 52 HC received three doses of SARS-CoV-2 vaccines. 283 (72,3%) participants received a booster dose of mRNA, and 108 (27,7%) participants received a booster dose of inactivated Coronavac. In all comparisons, patients treated with ocrelizumab had the lowest antibody titer (p<0.005). In the fingolimod group, booster mRNA caused a higher antibody titer than the inactivated vaccine. In total, pwMS had a lower antibody titer than HC regardless of the vaccine type. In regression analyses having a booster mRNA [beta= -0.671 (0.133) 95%CI= -0.933 - -0.409, p<0.001] and lower disease duration [beta-0.019 (0.010)95%CI= -0.038 - 0.000, p=0.44] were two markers which significantly associated with higher antibody titer in pwMS. Conclusion(s): The study shows that a third dose vaccine is an effective strategy to boost antibody response in the MS population, and the mRNA SARS CoV-2 vaccine's booster is preferable to inactivated ones.