Neurological

The effect of MS treatments on SARS-CoV-2 vaccines and humoral response

In patients with multiple sclerosis (MS), treatment with cladribine and teriflunomide was associated with an adequate humoral response to SARS-CoV-2 vaccines, while anti-CD20 therapies and sphingosine-1-phosphate (S1P) receptor modulators were associated with were associated with decreased response. according to study results published in JAMA Neurology. However, delaying anti-CD20 therapies by 3 to 6 months prior to vaccination may improve the response.

Previous studies have shown a significantly reduced humoral response to SARS-CoV-2 vaccines in patients with MS treated with fingolimod and ocrelizumab. The aim of the current study was to determine the impact of other disease-modifying treatments and the effect of delaying the anti-CD20 infusion on the humoral response to the vaccines.

The prospective observational cohort study involved 120 (mean age 55 years; 61.7% women) patients with MS from the Neurozentrum Südschweiz, including 58 patients treated with anti-CD20 therapies, 24 patients treated with teriflunomide, 15 patients treated with cladribine, and 9 patients treated with sphingosine-1-phosphate receptor (S1P) modulators and 14 patients received no MS therapy.

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All participants received 2 doses of SARS-CoV-2 messenger RNA vaccine and had serum samples collected within 2 weeks before the first vaccination dose and 21-35 days after the second dose to assess post-vaccination immunoglobulin G (IgG) production to determine.

While all patients with teriflunomide and those in the group without therapy were seropositive in the second serum sample, about half (48.2%) of the patients were in the anti-CD20 group and one third (33.3%) of the patients were in the S1P modulators group, and 7.1% in the cladribine group remained seronegative 21-35 days after the second dose of vaccine.

While there were no significant differences in SARS-CoV-2 IgG between patients who received no therapy and those treated with teriflunomide or cladribine, treatments with anti-CD20 and S1P modulators were lower in SARS-CoV -2 IgG (P <0.001) linked. .

The median time between the last anti-CD20 infusion and the first vaccine dose was 7.1 months, and the data suggest that there has been a progressive increase in SARS-CoV-2 over time since the last anti-CD20 infusion -IgG gave. The researchers suggested that the humoral response to vaccines might be better if anti-CD20 infusions are delayed 3 to 6 months before vaccination.

The study had several limitations, including the short follow-up time, the relatively small sample size, and the lack of data on additional disease-modifying treatments.

“Future studies should aim to examine antibody dynamics over time, whether and how T-cell-mediated post-vaccination responses are affected by DMTs, and whether these biological measures actually increase the vaccine’s effectiveness in preventing severe SARS -CoV-2 infection, “the researchers wrote.

Disclosure: Some study authors stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.

reference

Disanto G, Sacco R, Bernasconi E, et al. Association of disease-modifying treatment and anti-CD20 infusion timing with humoral response to 2 SARS-CoV-2 vaccines in patients with multiple sclerosis. JAMA Neurol. Published online 23 September 2021. doi: 10.1001 / jamaneurol.2021.3609

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