COVID-19 vaccine reactogenicity in persons with multiple sclerosis

ABSTRACT

Introduction: Limited data on SARS-CoV-2 vaccine reactogenicity in persons with multiple sclerosis (PwMS) exists and it is of interest due to the novel vaccine strategies deployed and the uncertain impact of disease modifying therapies (DMTs). Objective: To report real-world data on SARS-CoV-2 vaccine reactions in PwMS in the context of DMTs. Aim: To identify sociodemographic and clinical attributes associated with SARS-CoV-2 vaccine reactogenicity in PwMS. Methods: PwMS participating in iConquerMS (an online research network) completed detailed online surveys between 3/2021- 6/2021, and reported their SARS-CoV-2 vaccines, experiences of local (itch, pain, redness, swelling, or warmth at injection site) and systemic (fever, chills, fatigue, headache, joint pain, malaise, muscle ache, nausea, allergic, or other) reactions within 24 hours (reported as none, mild, moderate, or severe), and other attributes, including DMT use. Multivariable models characterized associations between predictors and reactogenicity after the 1st and 2nd vaccination. Results: In 719 PwMS, 64% reported a reaction and 17% reported a severe reaction after the 1st vaccine, which were primarily experiences of pain at injection site, fatigue, headache, and malaise. Younger age, being female, a prior SARS-CoV-2 infection, and receiving the ChAdOx1 nCoV-19 versus the BNT162b2 vaccine were independently associated with experiencing a reaction. Similar relationships were observed for experiencing a severe reaction, including higher reactogenicity for PwMS with greater physical impairment and lower reactogenicity for PwMS treated with an alpha4-integrin blocker or sphingosine-1-phosphate receptor modulator (SIPR). In 441 PwMS who received two vaccinations, 74% reported a reaction and 22% reported a severe reaction after the 2nd vaccine. Younger PwMS and those who received the mRNA-1273 versus the BNT162b2 vaccine reported higher reactogenicity, while those on a S1PR or fumarate reported fewer reactions. Similar relationships for age, vaccine type, and S1PR treatment were observed for experiencing a severe reaction after the 2nd vaccine. There were no differences in reactogenicity by MS subtype, disease duration, or for B-cell depleting DMTs across models. Conclusions: Factors associated with SARS-CoV-2 vaccine reactogenicity in the general population were similarly associated in PwMS. Intriguingly, PwMS on specific DMTs were significantly less likely to report vaccine reactions.