Abstract
Objective: The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines in people with multiple sclerosis (MS).
Methods: Four hundred seventy-three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (COVID-19) and vaccine history, medical, and drug history were extracted from questionnaires and medical records. Dried blood spots were eluted and tested for antibodies to SARS-CoV-2. Antibody titers were partitioned into tertiles with people on no disease modifying therapy as a reference. We calculated the odds ratio of seroconversion (univariate logistic regression) and compared quantitative vaccine response (Kruskal Wallis) following the SARS-CoV-2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response.
Results: Compared to no disease modifying therapy, the use of anti-CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01-0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01-0.12) were associated with lower seroconversion following the SARS-CoV-2 vaccine. All other drugs did not differ significantly from the untreated cohort. Both time since last anti-CD20 treatment and total time on treatment were significantly associated with the response to the vaccination. The vaccine type significantly predicted seroconversion, but not in those on anti-CD20 medications. Preliminary data on cellular T-cell immunity showed 40% of seronegative subjects had measurable anti-SARS-CoV-2 T cell responses.
Interpretation: Some disease modifying therapies convey risk of attenuated serological response to SARS-CoV-2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a-n/a.
【초록키워드】 COVID-19, Treatment, coronavirus disease, SARS-CoV-2, Vaccine, immune response, vaccination, therapy, multiple sclerosis, antibody, monoclonal antibody, risk, drug, medications, anti-SARS-CoV-2, Lymphocyte count, Cohort, Seroconversion, vaccine response, management, T cell responses, Patient, Logistic regression, age, disease, Quantitative, questionnaire, seronegative, Blood, SARS-CoV-2 vaccination, anti-CD20, T-cell immunity, serological response, cellular, Odds ratio, ANN, medical records, 95% CI, 95% confidence interval, subject, anti-CD20 treatment, recommendation, regression modeling, not differ, tested, predicted, significantly, provided, calculated, drug history, the SARS-CoV-2, 【제목키워드】 COVID-19, response, Multiple, sclerosis,