Humoral and cellular immune responses after SARS-CoV-2 vaccination

In a comprehensive study, antibody and cellular responses to SARS-CoV-2 vaccination in MS patients using different disease-modifying treatments (DMTs) were analysed. Fingolimod-treated MS patients had an impaired humoral response and highly reduced T-cell responses after SARS-CoV-2 vaccination. Cladribine-treated patients had reduced cellular responses.

This is one of the first studies that assessed immune responses after SARS-CoV-2-vaccination in MS patients treated with DMTs vaccinated after a previous SARS-CoV-2 infection and compared it with naïvely-vaccinated MS patients. It is also one of the first studies to investigate Th1 and Th2 cellular immune responses after SARS-CoV-2 vaccination in MS patients using a DMT [1].

Included MS patients were treated with fingolimod (n=38), cladribine (n=31), dimethyl fumarate (n=23), natalizumab (n=22), alemtuzumab (n=17), or teriflunomide (n=13). Healthy controls (n=43) served as a control group. Anti-CD20 medication was not included, as a similar study on this type of medication had been studied and recently published by a Swedish group [2]. The 183 participants received 2 vaccinations, as was customary at the time of the study. Of these, 146 were vaccinated without previously having contracted a SARS-CoV-2 infection (non-COVID cohort), while 37 were vaccinated after a previous SARS-CoV-2 infection (COVID cohort).

Results showed a decreased antibody response in fingolimod-treated participants, 4 and 12 weeks after vaccination, in both the non-COVID and the COVID cohort. Interferon (IFN)-gamma T-cell responses in fingolimod-treated participants were completely abrogated at week 4 and week 12 in both cohorts. Interleukin-13 T-cell responses were decreased in fingolimod-treated participants at week 4 and week 12 in the non-COVID cohort. Antibody levels for fingolimod and healthy controls were significantly higher in the COVID versus the non-COVID cohort. As for cladribine, antibody and IFN-gamma levels positively correlated with a longer time interval to the last cladribine treatment course at 12 weeks (not at 4 weeks).

These findings are relevant with regard to risk mitigation strategies and vaccination recommendations for MS patients.

1. Rabenstein M. Humoral and cellular immune responses after SARS-CoV-2-Vaccination in a Swedish cohort of persons with multiple sclerosis treated with disease modifying therapies. Abstract O138, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.
2. Högelin KA, et al. Eur J Neurol. 2022;29(11):3317–28.

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Posted on 20 December 202215 February 2024