COVID-19 Vaccine Response in People with Multiple Sclerosis

Tallantyre, Emma C.; Vickaryous, Nicola; Anderson, Valerie; Asardag, Aliye Nazli; Baker, David; Bestwick, Jonathan; Bramhall, Kath; Chance, Randy; Evangelou, Nikos; George, Katila; Giovannoni, Gavin; Godkin, Andrew; Grant, Leanne; Harding, Katharine E.; Hibbert, Aimee; Ingram, Gillian; Jones, Meleri; Kang, Angray S.; Loveless, Samantha; Moat, Stuart J.; Robertson, Neil P.; Schmierer, Klaus; Scurr, Martin J.; Shah, Sita Navin; Simmons, Jessica; Upcott, Matthew; Willis, Mark; Jolles, Stephen; Dobson, Ruth

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.

Citation

Tallantyre, E. C., Vickaryous, N., Anderson, V., Asardag, A. N., Baker, D., Bestwick, J., …Dobson, R. (2022). COVID-19 Vaccine Response in People with Multiple Sclerosis. Annals of Neurology, 91(1), 89-100. https://doi.org/10.1002/ana.26251

• Journal Article Type: Article
• Acceptance Date: Oct 18, 2021
• Online Publication Date: Oct 22, 2021
• Publication Date: Jan 1, 2022
• Deposit Date: Nov 18, 2021
• Publicly Available Date: Nov 18, 2021
• Journal: Annals of Neurology
• Print ISSN: 0364-5134
• Electronic ISSN: 1531-8249
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 91
• Issue: 1
• Pages: 89-100
• DOI: https://doi.org/10.1002/ana.26251
• Keywords: Clinical Neurology; Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/6729552
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1002/ana.26251