IgG immune response to SARS-CoV-2 vaccination in people living with multiple sclerosis within MS PATHS

ABSTRACT

Background: Data on the effects of multiple sclerosis (MS) disease modifying therapies (DMTs) on SARS-CoV-2 vaccine response are needed. Initial studies suggest CD20 cell depleting therapies and fingolimod attenuate IgG response to SARS-CoV-2 vaccination in MS patients (pts), consistent with previous studies of vaccine responses in pts treated with those DMTs. Methods: Participants with MS enrolled in the MS PATHS network in the US, Germany, and Spain were asked to provide blood serum samples up to 30 days pre-SARS-CoV-2 vaccination and 28-90 days post final vaccine dose. The goal is to obtain & ge;45 post-vaccination samples per approved DMT and among pts not currently treated with a DMT. Semi-quantitative measures of SARS-CoV-2 IgG response to spike protein (Siemens SARSCoV- 2 IgG assay) and nucleocapsid protein (Abbott SARS-CoV-2 IgG assay) will be used to distinguish humoral responses to vaccination vs prior infection. The impact of demographic factors, MS disease subtype and duration, disability level, DMT type, vaccine type, and time since last DMT dose, and vaccine dose on IgG response will be evaluated. Results: As of May 17, 2021, 379 unique pts provided a serum sample CD20 DMTs (n=139), S1P DMTs (n=31), natalizumab (n=39), other DMTs (n=117), and no DMT (n=53);183 pts have a pre-vaccination sample awaiting a post-vaccination sample, 186 have only a post-vaccination sample, and 10 have both. Prevaccination samples were collected at a mean (SD) of 4.5 (7.5) days prior to the first vaccine dose, and post-vaccination samples were collected 46.6 (15.2) days after the last dose, 91.8% following an mRNA vaccine. Pt (n=379) characteristics were age 50.3 (12.5) yrs, 67% female, disease duration 16.6 (9.6) yrs, 27.7% progressive MS, and Patient Determined Disease Steps 2.0 (2.3). Reactive IgG rates (IgG index & gt;1) from initial post-vaccination testing were CD20 DMTs 21/41 (51%), S1P DMTs 4/8 (50%), and 100% for all other groups, including natalizumab (n=9), fumarates (n=8), interferons (n=8), glatiramer acetate (n=8), teriflunomide (n=2), alemtuzumab (n=1) and no DMT (n=17). Conclusions: Preliminary results, based on a limited sample size, suggest CD20 and S1P DMTs may reduce IgG response to SARS-CoV-2 vaccination. Quantifying post-vaccination IgG response across DMTs is crucial to optimize MS management. Data from ongoing sample collection will be presented at the meeting.