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 .
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 . 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.
- 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.
- Högelin KA, et al. Eur J Neurol. 2022;29(11):3317–28.
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Table of Contents: ECTRIMS 2022
Letter from the Editor
ECTRIMS 2022 Highlights Podcast
Diagnosis and Prediction of Disease Course
A case for including optic nerve lesions in the McDonald criteria
Cerebrospinal fluid kappa-free light chains for MS diagnosis
Early, non-disabling relapses increase disability accumulation
Physical impairment is present before perceived MS onset
Chronic active MS lesions respond poorly to anti-CD20 antibodies
Treatment: Trials & Strategies
Dimethyl fumarate reduces the risk of a first clinical event in RIS
How and when to make a timely switch to high-efficacy DMT
Comparing real-world effectiveness of DMTs
Study fails to show non-inferiority of rituximab to ocrelizumab
Autologous haematopoietic stem cell transplantation versus DMTs
Stem cell transplantation not superior to natalizumab in progressive MS
Efficacy of DMTs fades away in secondary progressive MS
Smartphone tapping can help detect progressive MS
Early treatment with DMT effective in paediatric-onset MS
Fingolimod in paediatric MS: results of up to 6 years
Switching treatment after initial platform injectable DMT: real-world data
Pregnancy and infant outcomes in women receiving ocrelizumab
New safety data of anti-CD20 mAbs around pregnancy
MS activity and pregnancy outcomes after long-term use of natalizumab
Ravulizumab significantly reduced relapses in AQP4+ NMOSD
NMOSD patients are cognitively impaired regardless of serostatus
Evidence-based consensus on pregnancy in NMOSD
COVID-19 and MS: lessons learned thus far
Ocrelizumab and fingolimod increase the risk of COVID-19 and of worse outcomes
Humoral and cellular immune responses after SARS-CoV-2 vaccination
Re-myelination strategies in MS still pose many unanswered questions
MS associated with a broader Epstein-Barr virus specific T-cell receptor repertoire
Cognitive rehab and mindfulness reduce cognitive complaints in MS
Autologous haematopoietic stem cell transplantation
Promising results of intrathecal MSC-NTF cells in progressive MS
Transplantation of autologous mesenchymal stem cells