ABSTRACT
Introduction: In patients with Multiple Sclerosis (pwMS) disease- modifying therapies (DMTs) are known to affect immune response to antigens and possibly to SARS-CoV2 vaccine. Therefore, post-vaccination serological assessments are needed to evaluate the effect of the vaccine on SARS-CoV-2 antibody response. Objectives and aims: We designed a prospective multicenter cohort study enrolling pwMS who were scheduled for SARSCov- 2 vaccination with mRNA vaccines (BNT162b2, Pfizer/ BioNTech, Inc or mRNA-1273, Moderna Tx, Inc) to evaluate their effect on SARS-CoV-2 antibody response. Methods: A blood collection for the measure of SARS-CoV-2 antibody before the first vaccine dose and 4 weeks after the second dose was planned, with a centralized and blinded serological assessment (electrochemiluminescence immunoassay, ECLIA, Roche Diagnostics). Results: Preliminary data were collected on 780 pwMS (76% BNT162b2 and 24% mRNA-1273) who had pre- and 4-week post-vaccination blood assessments. 87 (11.2%) were untreated, 154 (19.7%) on ocrelizumab, 25 (3.2%) on rituximab, 85 (10.9%) on fingolimod, 25 (3.2%) on cladribine and 404 (51.7%) on other DMTs. 677 patients (86.8%) had detectable post-vaccination SARS-CoV-2 antibodies. At multivariate analysis, the antibody levels of patients on ocrelizumab (178-fold decrease, p<0.001), fingolimod (26-fold decrease, p<0.001) and rituximab (17-fold decrease, p<0.001) were significantly reduced as compared to untreated patients. Vaccination with mRNA-1273 resulted in a systematically 3.5-fold higher antibody level than with the BNT162b2 vaccine (p<0.001). Interpretation: In pwMS, anti-CD20 treatment and fingolimod led to a reduced humoral response to mRNA-based SARS-CoV-2 vaccines. As mRNA-1273 elicits 3.5-higher antibody levels than BNT162b2, this vaccine may be preferentially considered for patients under anti-CD20 treatment or fingolimod. Combining our data with those that will be produced by studying the cellular immune response to vaccines, and including clinical follow-up, will contribute to better define the most appropriate SARS-CoV-2 vaccine strategies in the context of DMTs and MS. At the time of the ECTRIMS presentation data on the full sample (about 2000 subjects) will be presented.
ABSTRACT
Background and aims: Bulbar palsy plus(BPp) is a variant of Guillain Barrè syndrome (GBS), characterized by bulbar symptoms and others cranial nerves deficits or ataxia, without limbs or neck weakness, usually associated with presence of GQ1b and Gt1a antibodies. Methods: We describe a case of BPp overlapped by a sensory-motor axonal neuropathy (ASMAN). Results: A 62 years old man, without relevant medical history, was admitted to Emergency Room for dysphagia, voice reduction and paraesthesia to distal extremities started 4 days earlier, after a diarrhoeic episode. Neurological examination showed absent tendon reflexes, mild ophthalmoparesis and asymmetrical palpebral ptosis. Cerebrospinal fluid(CSF) analysis and neurophysiological study(NPS) were normal, showing only absent H reflex. Repetitive nerve stimulation at low and high frequencies was normal. Intravenous immunoglobulins 0,4 gr/kg die for 5 days were started. Subsequently he developed tetra-hyposthenia and worsening of bulbar function, complete gaze palsy and bilateral ptosis, requiring mechanical ventilation and nasogastric tube. 15 days after symptoms onset, CSF analysis showed albuminocytological dissociation and NPS showed diffuse sensory-motor axonal neuropathy. Initially no serum anti ganglioside were detected, but 15 days after GT1a, Gq1b, GD2 and GD3 IgG were positive. RT-PCR and serology for SARS-COV 2 were negative. Campylobacter search was negative. About 15 days after onset he started recovery and at 50 days he was discharged from rehabilitative ward. Conclusions: BPp is recently recognised as a rare GBS variant, such as Miller Fisher syndrome (MFS) or pharyngeal-cervical-brachial (PCB) variant. Overlap between AMSAN and the other variants was already described. This is an interesting case of BPp/ASMAN overlap syndrome.