Correspondence: Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies

Background and Aims: The National Multiple Sclerosis Society and other expert organizations recommended that all patients with multiple sclerosis (MS) should be vaccinated against COVID-19. However, the effect of disease-modifying therapies (DMTs) on the efficacy to mount an appropriate immune response is unknown. We aimed to characterize humoral immunity in mRNA-COVID-19 MS vaccinees treated with high-efficacy DMTs. Methods: We measured SARS-CoV-2 IgG response using anti-spike protein-based serology (EUROIMMUN) in 125 MS patients vaccinated with BNT162b2-COVID-19 vaccine 1 month after the second dose. Patients were either untreated or under treatment with fingolimod, cladribine, or ocrelizumab. A group of healthy subjects similarly vaccinated served as control. The percent of subjects that developed protective antibodies, the titer, and the time from the last dosing were evaluated. Results: Protective humoral immunity of 97.9%, 100%, 100%, 22.7%, and 3.8%, was observed in COVID-19 vaccinated healthy subjects ( N = 47), untreated MS patients ( N = 32), and MS patients treated with cladribine ( N = 23), ocrelizumab ( N = 44), and fingolimod ( N = 26), respectively. SARS-CoV-2 IgG antibody titer was high in healthy subjects, untreated MS patients, and MS patients under cladribine treatment, within 29.5–55 days after the second vaccine dose. Only 22.7% of patients treated with ocrelizumab developed humoral IgG response irrespective to normal absolute lymphocyte count. Most fingolimod-treated MS patients had very low lymphocyte count and failed to develop SARS-COV-2 antibodies. Age, disease duration, and time from the last dosing did not affect humoral response to COVID-19 vaccination. Conclusions: Cladribine treatment does not impair humoral response to COVID-19 vaccination. We recommend postponing ocrelizumab treatment in MS patients willing to be vaccinated as a protective humoral response can be expected only in some. We do not recommend vaccinating MS patients treated with fingolimod as a protective humoral response is not expected.

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Free Light Chains of Immunoglobulins in Multiple Sclerosis: A Putative Index of the Intrathecal Humoral Immune Response

Cellular and Humoral Immunological Components of Cerebrospinal Fluid in Multiple Sclerosis ◽

10.1007/978-1-4899-5348-3_23 ◽

1987 ◽

pp. 187-200 ◽

Cited By ~ 1

Author(s):

Richard A. Rudick

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

Humoral Immune Response ◽

Light Chains ◽

Free Light Chains ◽

Humoral Immune

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Biomarkers related to the intrathecal humoral immune response as laboratory tools for multiple sclerosis diagnosis

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.118168 ◽

2021 ◽

Vol 429 ◽

pp. 118168

Author(s):

Sawsan Feki ◽

Salma Sakka ◽

Sabrina Mejdoub ◽

Mariem Damak ◽

Hend Hachicha ◽

...

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

Humoral Immune Response ◽

Humoral Immune ◽

Multiple Sclerosis Diagnosis

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Protecting people with multiple sclerosis through vaccination

Practical Neurology ◽

10.1136/practneurol-2020-002527 ◽

2020 ◽

Vol 20 (6) ◽

pp. 435.1-445

Author(s):

Saúl Reyes ◽

Mary Ramsay ◽

Shamez Ladhani ◽

Gayatri Amirthalingam ◽

Neena Singh ◽

...

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

Patient Education ◽

Current Literature ◽

Morbidity And Mortality ◽

Disease Modifying Therapies ◽

Specific Advice ◽

Disease Modifying ◽

Cost Efficient ◽

To Receive

Vaccination is one of the most effective and cost-efficient methods for protecting people with multiple sclerosis (MS) from infections. However, use of vaccines has often been problematic because of misguided concerns that they may exacerbate the disease and/or that some disease-modifying therapies may influence the immune response to immunisations and/or their safety. People with MS risk higher morbidity and mortality from vaccine-preventable infections. It is, therefore, important to address any patient’s reluctance to accept vaccination and to provide clear guidance for clinicians on which vaccinations to consider proactively. We have reviewed the current literature and provide recommendations regarding vaccines in adults with MS, including specific advice regarding vaccination safety in patients receiving—or going to receive—disease-modifying therapies, vaccination during pregnancy, pretravel counselling and patient education.

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B Cell-Related Chemokine (CXCL13) in CSF is Correlated with the Intrathecal Humoral Immune Response in Patients with Multiple Sclerosis

Multiple Sclerosis and Related Disorders ◽

10.1016/j.msard.2019.11.044 ◽

2020 ◽

Vol 37 ◽

pp. 101569

Author(s):

Sawsan Feki ◽

Mariem Dammak ◽

Sabrina Mejdoub ◽

Saba Gargouri ◽

Salma Sakka ◽

...

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

B Cell ◽

Humoral Immune Response ◽

Humoral Immune

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Antibody response against HERV-W env surface peptides differentiates multiple sclerosis and neuromyelitis optica spectrum disorder

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217317742425 ◽

2017 ◽

Vol 3 (4) ◽

pp. 205521731774242 ◽

Cited By ~ 1

Author(s):

Giannina Arru ◽

Elia Sechi ◽

Sara Mariotto ◽

Alessia Farinazzo ◽

Chiara Mancinelli ◽

...

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

Neuromyelitis Optica ◽

Humoral Immune Response ◽

Serum Levels ◽

Spectrum Disorder ◽

Antigenic Peptides ◽

Neuromyelitis Optica Spectrum Disorder ◽

Serum Samples ◽

Humoral Immune

Background A specific humoral immune response against HERV-W envelope surface (env-su) glycoprotein antigens has been reported in serum of patients with multiple sclerosis (MS). However, it has not been evaluated to date in patients with neuromyelitis optica spectrum disorder (NMOSD). Objective The objective of this paper is to investigate whether antibody (Ab) response against HERV-W env-su antigenic peptides differs between NMOSD and MS. Methods Serum samples were collected from 36 patients with NMOSD, 36 patients with MS and 36 healthy control individuals (HCs). An indirect ELISA was set up to detect specific Abs against HERV-W env-su peptides. Results Our data showed that two antigenic peptides, particularly HERV-Wenv93–108 and HERV-Wenv248–262, were statistically significantly present only in serum of MS compared to NMOSD and HCs. Thus, the specific humoral immune response against HERV-W env-su glycoprotein antigens found in MS is widely missing in NMOSD. Conclusion Increased circulating serum levels of these HERV-W Abs may be suitable as additional biomarkers to better differentiate MS from NMOSD.

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Initial high-efficacy disease-modifying therapy in multiple sclerosis

Neurology ◽

10.1212/wnl.0000000000010135 ◽

2020 ◽

Vol 95 (8) ◽

pp. e1041-e1051 ◽

Cited By ~ 2

Author(s):

Mathias Due Buron ◽

Thor Ameri Chalmer ◽

Finn Sellebjerg ◽

Ismael Barzinji ◽

Jeppe Romme Christensen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Lower Probability ◽

Matched Sample ◽

Class Iii ◽

High Efficacy ◽

Disease Modifying Therapies ◽

Baseline Activity ◽

First Relapse ◽

Disease Modifying ◽

Edss Score

ObjectiveTo determine the effectiveness of high-efficacy disease-modifying therapies (heDMTs) vs medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naive patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry.MethodsWe identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity score matched sample of patients starting meDMT.ResultsWe included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval [CI] 10.4%–23.0%) and 30.1% (95% CI 23.1%–37.1%) for heDMT and meDMT initiators, respectively (hazard ratio [HR] 0.53, 95% CI 0.33–0.83, p = 0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37–0.67). Results were similar after pairwise censoring and in subgroups with high baseline activity, diagnosis after 2006, or information on baseline T2 lesion load.ConclusionWe found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT.Classification of evidenceThis study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.

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