Infectious Disease

mRNA COVID-19 vaccines effective in patients with MS receiving disease-modifying therapies

December 03, 2021

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Disclosure:
Tortorella reports that she has received lecture fees, travel grants, and advisory boards from Almirall, Bayer-Schering, Biogen, Merck-Serono, Mylan, Novartis, Roche, Sanofi, and Teva. Please refer to the study for all relevant financial information from the other authors.

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Messenger RNA COVID-19 vaccination was effective in most patients with MS who used various disease-modifying therapies, according to study results published in Neurology.

However, the level of protection seemed to differ depending on the drug used.

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“Our study aimed to focus on patients with MS, representatives of a subset of the population at an overall increased risk of serious COVID-19 outcomes compared to healthy individuals due to treatment with various immunomodulatory or immunosuppressive drugs.” Delia Goletti, MD, PhD, from the Translational Research Unit of the National Institute of Infectious Diseases Lazzaro Spallanzani-IRCCS in Italy, said Healio Neurology. “We have examined the effect of therapy schemes in MS patients in order to build up a coordinated serological and T-cell-specific immune response to SARS-CoV-2 one month after the complete mRNA-based vaccination.”

Using two parallel prospective studies conducted in Italy, the researchers enrolled medical staff (n = 78) and patients with MS (n = 108) who had followed the two-dose regimen of an mRNA-based one for the past 2 years The vaccine against COVID-19 had completed up to 4 weeks. They examined the serological response via region-binding domain (RBD) quantification and neutralizing antibodies. They used a whole blood test to quantify the interferon (IFN) gamma response to spike peptides to analyze the cell-mediated response. They used fluorescence-activated cell sorting analysis to locate cells that responded to the spike stimulation. Of the MS patients, 28 were treated with IFN-beta, 35 with fingolimod, 20 with cladribine and 25 with ocrelizumab.

The results showed a lower anti-RBD antibody response rate in patients treated with ocrelizumab (40%; P <0.0001) and fingolimod (85.7%; P = 0.0023) compared to healthcare professionals and patients treated with cladribine or IFN-beta. were treated. Patients treated with ocrelizumab (p <0.0001), fingolimod (p <0.0001), and cladribine (p = .01) had a lower mediantiter against RBD antibodies than medical staff and patients treated with IFN- beta were treated.

All health care workers tested, but only 16.6% of fingolimod-treated patients, had serum-neutralizing activity. The researchers found a T-cell-specific response in 62% of MS patients, even though IFN-gamma levels were significantly lower when compared to health care workers. They observed the lowest frequency of T cell responses in patients treated with fingolimod (14.3%). Goletti and colleagues found a correlation between the T-cell-specific response and the lymphocyte count and the anti-RBD antibody titer. CD4 + and CD8 + T cells mediated an IFN-gamma T cell response.

“Evaluating the effectiveness of the anti-SARS-CoV-2 vaccination in people with MS is of great scientific and clinical interest in order to optimize the clinical management of these patients during the current COVID-19 pandemic,” said Goletti. “In the present study, we have shown that COVID-19 vaccines induce humoral and / or cell-mediated specific immunity in most patients with MS, albeit to varying degrees, and this is related to the treatment used. These results promote COVID-19 vaccination in MS patients. ”

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