ABSTRACT
Introduction: Personal social networks impact the quality of life of people living with multiple sclerosis (pwMS). Objective / Aims: To evaluate the dynamic associations between personal network features and neurological function in pwMS and control participants during the COVID-19 pandemic and compare with the pre-pandemic period. Method(s): We first analyzed data collected from 8 cohorts of pwMS and control participants during the COVID-19 pandemic from March-December 2020. We then leveraged data collected between 2017-2019 in 3 of the 8 cohorts for longitudinal comparison. Participants completed a personal network questionnaire, which quantified the structure and composition of each person's personal network, including the health behaviors of network members. Neurological disability was quantified by three interrelated patient-reported outcomes: Patient Determined Disease Steps (PDDS), Multiple Sclerosis Rating Scale-Revised (MSRS-R), and Patient Reported Outcomes Measurement Information System (PROMIS)-Physical Function. We identified the network features associated with neurologic disability using paired t-tests and covariate-adjusted regressions. Result(s): In the cross-sectional analysis of the pandemic data from 1130 pwMS and 1250 control participants, percentage of network members perceived to have a negative health influence was associated with greater neurological symptom burden in pwMS (MSRS-R: Beta[95% CI]=2.181[1.082, 3.279], p<.001) and worse physical function in control participants (PROMIS-Physical Function: Beta[95% CI]=-5.707[-7.405, -4.010], p<.001). In the longitudinal analysis of 230 pwMS and 136 control participants, the percentage of people contacted weekly or less (p<.001) decreased during the COVID-19 pandemic for both pwMS (0.30+/-0.26 v. 0.19+/-0.22) and controls (0.23+/-0.25 v. 0.15+/-0.21) when compared to the pre-pandemic period. PwMS further experienced a greater reduction in network size (p<.001), increase in constraint (a measure of close ties of the network, p<.001) and decrease in maximum degree (highest number of ties of a network member, p<.001) than controls during the COVID-19 pandemic. These changes in network features were not associated with worsening neurological disability. Conclusion(s): Our findings suggest that negative health influences in personal networks are associated with worse disability in all participants and COVID-19 pandemic led to contraction of personal networks to a greater extent for pwMS than controls.
ABSTRACT
Introduction: Vaccine hesitancy is a major barrier to achieving herd immunity against COVID-19. This is especially apparent in patients with autoimmune diseases, such as multiple sclerosis (MS), who were largely excluded from seminal vaccine trials. Objectives/Aims: To assess COVID-19 vaccine hesitancy and early safety/tolerability in patients with MS and related disorders. Methods: Participants were recruited from multiple academic centers as part of the MS Resilience to COVID-19 (MSReCOV) Study Consortium. Statistical analysis was performed on responses to vaccine-specific questionnaires completed between February 24th and April 28th, 2021. Results: 1761 participants completed the vaccine questionnaire, including 1081(62%) with MS or another neuroinflammatory disease (NID), and 657(38%) controls. By survey completion, 1150(65%) participants had been vaccinated against SARS-CoV-2 with Pfizer(n=526, 54%), Moderna(n=415, 43%), Johnson & Johnson(n=22, 2%), AstraZeneca(n=2, 0.2%), or unknown(n=3, 0.3%). 82%(n=568) of MS/NID were on disease modifying therapy at the time of vaccination. Hesitancy rates were similar between MS/NID and controls(p=0.39), with 32% of unvaccinated participants(n=597, 34%) either unsure or not planning to be vaccinated. The most common reasons for hesitancy in patients with MS/NID pertained to vaccines being understudied in the autoimmune population(n=35, 54%), triggering a demyelinating event(n=30, 46%), or being too new(n=24, 37%). Of the MS/NID participants vaccinated with mRNA vaccines, 42%(n=240) and 45%(n=178) reported side effects(SE) after the first and second doses, respectively. Higher rates of SEs were noted in the MS/NID group after the second dose (67% vs. 45%;p<0.0001;RR 1.5, 95%CI:1.3 - 1.7). Most common SEs in the MS/NID groups were arm soreness(n=278, 85%), flu-like symptoms(n=139, 42%), and headache(n=23, 7%). Only 1 MS/ NID patient (vs. 3 controls) reported a neurologic SE other than headache, described as transient numbness. When comparing vaccinated and unvaccinated MS/NID patients, there was no difference in rates of recurrent neurologic symptoms(p=0.45), new neurologic symptoms(p=0.65) or new/ active lesions detected on MRI(p=0.35). Conclusions: Reasons for vaccine hesitancy in MS/NID population include lack of study in autoimmune population and fear of relapse. In this early analysis we found a higher rate of expected SEs after second mRNA dose but no evidence of worsening neurologic disease.
ABSTRACT
Background: Vaccination for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has already resulted in a reduction in new infection and mortality cases. Preliminary reports indicate variable and reduced antibody response in multiple sclerosis (MS) patients treated with different disease-modifying therapies (DMTs). Objective and Aim: To determine the effects of different DMT on the humoral response after COVID-19 vaccination in MS patients. Methods: A total of 154 MS patients were vaccinated with one of three available SARS-CoV-2 vaccines (BNT162b2, mRNA-1273, and Ad26.COV2.S). The humoral response was determined by measurement of either unspecific IgG antibodies or anti-spike IgG antibodies. The time between vaccination and serological testing and time from the last infusion date (if applicable) to testing were determined. Humoral response greater than 1.0 was considered as positive and suggestive of acquired immunity. Results: Overall, 89 out of 127 (70.1%) and 15 out of 27 (55.6%) MS patients had a positive anti-S1 test and unspecific IgG test, respectively. Excluded from the analysis were two patients who had only one dose of the mRNA vaccine with negative seroconversion and four patients with a history of SARS-CoV-2 PCRpositive test and positive seroconversion. In the remaining sample, there were no sex and age differences in seroconversion (both p>0.05). Based on DMT groups, seroconversion was seen in 22/26 (84.6%) patients treated with interferon-β, 18/19 (94.7%) on glatiramer acetate, 14/16 (87.5%) on natalizumab, 6/10 (60%) on teriflunomide, 3/8 (37.5%) on sphingosine-1-phosphate (S1P) modulators, 9/9 (100%) on dimethyl fumarate, 0/3 (0%) on cladribine (but all of these patients had prior ocrelizumab from 8 to 9 months prior), 4/28 (14.3%) on anti-CD20 depleters, and 3/5 (60%) on off-label medications. 87.5% (21/24) of non-treated MS patients had positive seroconversion. Seroconverted MS patients treated with anti-CD20 had numerically greater time from the last infusion to the first vaccination (162.3 vs. 80.9 days). Conclusion: MS patients treated with B-cell depleting medications and S1P modulators have significantly lower seroconversion after COVID-19 vaccination when compared to DMT-naive patients and other DMT groups. Future studies should determine the risk of severe clinical outcomes in vaccinated patients with no evidence of seroconversion.