Risk of COVID-19 in people with multiple sclerosis who are seronegative following vaccination

Zaloum, Safiya A; Wood, Callum H; Tank, Pooja; Upcott, Matthew; Vickaryous, Nicola; Anderson, Valerie; Baker, David; Chance, Randy; Evangelou, Nikos; George, Katila; Giovannoni, Gavin; Harding, Katharine E; Hibbert, Aimee; Ingram, Gillian; Jolles, Stephen; Kang, Angray S; Loveless, Samantha; Moat, Stuart J; Richards, Aidan; Robertson, Neil P; Rios, Francesca; Schmierer, Klaus; Willis, Mark; Dobson, Ruth; Tallantyre, Emma C

Abstract

Background:

People with multiple sclerosis (pwMS) treated with certain disease-modifying therapies (DMTs) have attenuated IgG response following COVID-19 vaccination; however, the clinical consequences remain unclear.

Objective:

To report COVID-19 rates in pwMS according to vaccine serology.

Methods:

PwMS with available (1) serology 2–12 weeks following COVID-19 vaccine 2 and/or vaccine 3 and (2) clinical data on COVID-19 infection/hospitalisation were included. Logistic regression was performed to examine whether seroconversion following vaccination predicted risk of subsequent COVID-19 infection after adjusting for potential confounders. Rates of severe COVID-19 (requiring hospitalisation) were also calculated.

Results:

A total of 647 pwMS were included (mean age 48 years, 500 (77%) female, median Expanded Disability Status Scale (EDSS) 3.5% and 524 (81%) exposed to DMT at the time of vaccine 1). Overall, 472 out of 588 (73%) were seropositive after vaccines 1 and 2 and 222 out of 305 (73%) after vaccine 3. Seronegative status after vaccine 2 was associated with significantly higher odds of subsequent COVID-19 infection (odds ratio (OR): 2.35, 95% confidence interval (CI): 1.34–4.12, p = 0.0029), whereas seronegative status after vaccine 3 was not (OR: 1.05, 95% CI: 0.57–1.91). Five people (0.8%) experienced severe COVID-19, all of whom were seronegative after most recent vaccination.

Conclusion:

Attenuated humoral response to initial COVID-19 vaccination predicts increased risk of COVID-19 in pwMS, but overall low rates of severe COVID-19 were seen.

Citation

Zaloum, S. A., Wood, C. H., Tank, P., Upcott, M., Vickaryous, N., Anderson, V., Baker, D., Chance, R., Evangelou, N., George, K., Giovannoni, G., Harding, K. E., Hibbert, A., Ingram, G., Jolles, S., Kang, A. S., Loveless, S., Moat, S. J., Richards, A., Robertson, N. P., …Tallantyre, E. C. (2023). Risk of COVID-19 in people with multiple sclerosis who are seronegative following vaccination. Multiple Sclerosis Journal, 29(8), 979-989. https://doi.org/10.1177/13524585231185247

• Journal Article Type: Article
• Acceptance Date: Apr 22, 2023
• Online Publication Date: Jul 11, 2023
• Publication Date: 2023-07
• Deposit Date: Apr 26, 2023
• Publicly Available Date: Jul 11, 2023
• Journal: Multiple Sclerosis Journal
• Print ISSN: 1352-4585
• Electronic ISSN: 1477-0970
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 8
• Pages: 979-989
• DOI: https://doi.org/10.1177/13524585231185247
• Keywords: Multiple sclerosis (MS); COVID-19; vaccination; disease-modifying therapies (DMTs); immune response
• Public URL: https://nottingham-repository.worktribe.com/output/20000352
• Publisher URL: https://journals.sagepub.com/doi/abs/10.1177/13524585231185247