ABSTRACT
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.
ABSTRACT
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.