SARS-CoV-2 vaccination in CIDP and MMN: more benefit than harm

SARS-CoV-2 vaccination in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) seems to be associated with a small increased risk of disease relapse. However, the overall benefits of vaccination in patients with CIDP or multifocal motor neuropathy (MMN) outweigh the risk of relapse. The short-term safety profile of SARS-CoV-2 vaccination in these patients is acceptable with only mild to moderate local and systemic adverse events.

In March 2021, the CDC stated: “People with autoimmune conditions (including preceding Guillain-Barré syndrome) may receive a COVID-19 vaccine. However, it should be noted that no data are currently available on the safety of COVID-19 vaccines for people with autoimmune conditions.” This was the rationale for a group of Italian researchers to assess the risk of relapse after SARS-CoV-2 vaccination in patients with CIDP or MMN [1]. In this multicentre, cohort, case-crossover study, the frequency of relapse in CIDP and MMN patients who received and did not receive a vaccination were compared.

Researchers included 336 patients: 278 with CIDP and 58 with MMN. Most patients were treated with intravenous or subcutaneous immunoglobulin therapy (IVIg 44%, SCIg 23%) and 16% received no treatment. In total, 307 (91%) underwent SARS-CoV-2 vaccination: 269 (88%) with BNT-162b2 (Pfizer/BioNTech), 28 (9%) with mRNA-1273 (Moderna), and 10 (3%) with ChAdOx1 (AstraZeneca).

In the group of 29 unvaccinated patients, no clinical relapse was observed during the 3 months of follow-up. In the vaccinated group, 16 patients (5%; 13 CIDP, 3 MMN) had a relapse (RR 3.21; 95% CI 0.19–52.25). This difference was not statistically significant. However, during the 3-month control period before vaccination, only 3 patients (1%) relapsed. Therefore, the risk of relapse was increased after vaccination (RR 4.00; 95% CI 1.35–11.82). This increase was mainly driven by CIDP patients (RR 3.25; 95% CI 1.07–9.84). Of the 16 patients who relapsed, 4 did so after the first vaccination and 12 after the second. About 30% of these patients relapsed within a week after vaccination, which might indicate a causal relationship. In 12 patients, relapse required adjustment of therapy. The short-term safety profile of SARS-CoV-2 vaccination in this study was acceptable, with local and systemic adverse events almost exclusively being mild to moderate.

1. Doneddu PE, et al. Risk of disease relapse and safety of SARS-CoV-2 vaccination in patients with chronic inflammatory neuropathies. EAN 2023 Annual Meeting, 1–4 July, Budapest, Hungary.

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Posted on 7 September, 202315 February, 2024