scholarly journals Clinical features and outcomes of COVID-19 despite SARS-CoV-2 vaccination in people with multiple sclerosis

2021 ◽  
Vol 7 (4) ◽  
pp. 205521732110571
Author(s):  
Deja R Rose ◽  
Ahmad Z Mahadeen ◽  
Alise K Carlson ◽  
Sarah M Planchon ◽  
Jennifer Sedlak ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
At Risk ◽  
Cleveland Clinic ◽  
Serological Response ◽  
Limited Data ◽  
Disease Modifying Therapy ◽  
Sphingosine 1 Phosphate ◽  
Disease Modifying ◽  
Anti Cd20 ◽  
Receptor Modulators

Background Several studies have demonstrated reduced serological response to vaccines in patients treated with anti-CD20 agents. However, limited data exist surrounding the clinical effect of disease modifying therapy (DMT) use on vaccine efficacy. Objectives To investigate breakthrough coronavirus disease 2019 (COVID-19) in vaccinated people with multiple sclerosis (PwMS) on DMT. Methods PwMS on DMT diagnosed with COVID-19 after full vaccination were identified from an existing Cleveland Clinic COVID-19 registry, supplemented by provider-identified cases. Demographics, disease history, DMTs, comorbidities, exposures, vaccination status, and COVID-19 outcomes were confirmed by review of the electronic medical record. Results Thirteen (3.8%) of 344 fully vaccinated people with multiple sclerosis on disease modifying therapy were diagnosed with COVID-19 after vaccination. Ten patients (76.9%) were on an anti-CD20 therapy, the remaining 3 (23.1%) on fingolimod. Only 2 patients (15.4%), both on anti-CD20 therapy, required hospitalization and steroid treatment. Neither required Intensive Care Unit admission. Conclusion Patients treated with anti-CD20 agents and sphingosine 1-phosphate receptor modulators may still be at risk for COVID-19 despite vaccination. While still at risk for hospitalization, intubation and death from COVID-19 appear rare. Larger studies analyzing how this may differ in the setting of emerging variants are needed.

scholarly journals COVID-19 vaccine response in people with multiple sclerosis

2021 ◽  
Author(s):  
Emma C Tallantyre ◽  
Nicola Vickaryous ◽  
Valerie Anderson ◽  
Aliye Nazli Asardag ◽  
David Baker ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Serological Response ◽  
Vaccine Response ◽  
Disease Modifying Therapy ◽  
Disease Modifying Therapies ◽  
Vaccine Type ◽  
Disease Modifying ◽  
Anti Cd20

Objective: To investigate the effect of disease modifying therapies on serological response to SARS-CoV2 vaccines in people with multiple sclerosis Methods: 473 people with multiple sclerosis from 5 centres provided one or more dried blood spot samples and a questionnaire about COVID-19 and vaccine history. Information about disease and drug history was extracted from their medical records. Dried blood spots were eluted and tested for antibodies to SARS-CoV2 receptor binding domain. Seropositivity was expressed according to validated cut-off indices. Antibody titers were partitioned into tertiles using data from 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 SARS-CoV2 vaccine according to disease modifying therapy. We used regression modelling to explore the effect of factors including 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 0.01-0.06, p<0.001) and fingolimod (odds ratio 0.41; 95% confidence interval 0.01-0.12) were associated with lower seroconversion following SARS-CoV2 vaccine. All other drug groups did not differ significantly from the untreated cohort. Both time since last anti-CD20 treatment and total time on treatment were significantly related with serological response to vaccination. Vaccine type significantly predicted seroconversion, but not in those on anti-CD20 medications. Interpretation: Some disease modifying therapies carry a risk of attenuated response to SARS-CoV2 vaccination in people with MS. We provide recommendations for the practical management of this patient group.

scholarly journals Immunoglobulin G immune response to SARS-CoV-2 vaccination in people living with multiple sclerosis within Multiple Sclerosis Partners Advancing Technology and Health Solutions

2022 ◽  
pp. 135245852110613
Author(s):  
Jeffrey A Cohen ◽  
Robert A Bermel ◽  
Cynthia I Grossman ◽  
Carrie M Hersh ◽  
Megan Hyland ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Immunoglobulin G ◽  
Post Vaccination ◽  
Vaccination Response ◽  
Disease Modifying Therapies ◽  
Igg Index ◽  
Sphingosine 1 Phosphate ◽  
Anti Cd20 ◽  
The Impact ◽  
Receptor Modulators

Background: The impact of multiple sclerosis (MS) disease-modifying therapies (DMTs) on SARS-CoV-2 vaccination response is uncertain. Methods: Post-SARS-CoV-2 vaccination blood samples across multiple DMTs were tested for SARS-CoV-2 immunoglobulin G (IgG) response. Results: Three hundred twenty-two people with MS were included; 91.9% received an mRNA vaccine. Post-vaccination reactive IgG rates (IgG index > 1) were 40% for anti-CD20 (32/80 patients); 41% for sphingosine 1-phosphate receptor modulators (S1PRM, 16/39); and 100% for all other classes, including the no DMT group. Conclusion: Anti-CD20 therapies and S1PRMs reduce IgG response to SARS-CoV-2 vaccination; IgG response is preserved with other DMTs.

scholarly journals COVID-19 Vaccination in Patients With Multiple Sclerosis on Disease-Modifying Therapy

2021 ◽  
pp. 10.1212/CPJ.0000000000001088
Author(s):  
Andrew Wolf ◽  
Enrique Alvarez
Keyword(s):  
Multiple Sclerosis ◽  
Immunological Response ◽  
Mechanisms Of Action ◽  
Vaccine Effectiveness ◽  
Neurological Deficits ◽  
Disease Modifying Therapy ◽  
Disease Modifying Therapies ◽  
Increase Risk ◽  
Disease Modifying ◽  
Anti Cd20

ABSTRACTThe COVID-19 pandemic has resulted in challenges for the practice of neurology. One major concern is how to best manage patients with multiple sclerosis who are on disease modifying therapies (DMT). DMTs frequently have immunosuppressive properties that both increase risk for COVID-19 and potentially reduce the immunological response to vaccination in a group already vulnerable to infection due to neurological deficits. Here, we review early data on COVID-19 outcomes in patients with MS and discuss what is known about vaccine effectiveness in those on anti-CD20 and S1PR agents, which are proposed to have attenuating effects based on their mechanisms of action. In addition, we provide recommendations to best utilize novel COVID-19 vaccines in this population and highlight what information may better inform vaccine strategies in the future.

scholarly journals COVID-19 outcomes in MS

2020 ◽  
Vol 7 (5) ◽  
pp. e835 ◽  
Author(s):  
Erica Parrotta ◽  
Ilya Kister ◽  
Leigh Charvet ◽  
Carrie Sammarco ◽  
Valerie Saha ◽  
...  
Keyword(s):  
Critical Illness ◽  
Care Center ◽  
Fatal Outcome ◽  
Entire Group ◽  
Neurologic Symptom ◽  
Disease Modifying Therapy ◽  
Increased Risk ◽  
Sphingosine 1 Phosphate ◽  
Anti Cd20 ◽  
Receptor Modulators

ObjectiveTo report outcomes on patients with multiple sclerosis (MS) and related disorders with coronavirus disease 2019 (COVID-19) illness.MethodsFrom March 16 to April 30, 2020, patients with MS or related disorders at NYU Langone MS Comprehensive Care Center were identified with laboratory-confirmed or suspected COVID-19. The diagnosis was established using a standardized questionnaire or by review of in-patient hospital records.ResultsWe identified 76 patients (55 with relapsing MS, of which 9 had pediatric onset; 17 with progressive MS; and 4 with related disorders). Thirty-seven underwent PCR testing and were confirmed positive. Of the entire group, 64 (84%) patients were on disease-modifying therapy (DMT) including anti-CD20 therapies (n = 34, 44.7%) and sphingosine-1-phosphate receptor modulators (n = 10, 13.5%). The most common COVID-19 symptoms were fever and cough, but 21.1% of patients had neurologic symptom recrudescence preceding or coinciding with the infection. A total of 18 (23.7%) were hospitalized; 8 (10.5%) had COVID-19 critical illness or related death. Features more common among those hospitalized or with critical illness or death were older age, presence of comorbidities, progressive disease, and a nonambulatory status. No DMT class was associated with an increased risk of hospitalization or fatal outcome.ConclusionsMost patients with MS with COVID-19 do not require hospitalization despite being on DMTs. Factors associated with critical illness were similar to the general at-risk patient population. DMT use did not emerge as a predictor of poor COVID-19 outcome in this preliminary sample.

scholarly journals Impact of COVID-19 on multiple sclerosis care and management: Results from the European Committee for Treatment and Research in Multiple Sclerosis survey

2021 ◽  
pp. 135245852110053
Author(s):  
Emilio Portaccio ◽  
Mattia Fonderico ◽  
Bernhard Hemmer ◽  
Tobias Derfuss ◽  
Bruno Stankoff ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Access To Care ◽  
Online Survey ◽  
Dimethyl Fumarate ◽  
Standards Of Care ◽  
Treatment Practices ◽  
European Committee ◽  
Disease Modifying Therapy ◽  
Anti Cd20 ◽  
The Impact

Background: The spread of Coronavirus disease-19 (COVID-19) poses unique challenges in the management of people with multiple sclerosis (PwMS). Objectives: To collect data about the impact of COVID-19 emergency on access to care for PwMS and on MS treatment practices. Methods: Between March and July 2020, the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) promoted an online survey covering patient access to care, management of relapses and visits, disease-modifying therapy (DMT) and experience with COVID-19. Results: Three-hundred and sixty neurologists from 52 countries (68% from Europe) completed the survey. 98% reported COVID-19-related restrictions. Telemedicine was adopted to overcome the limited access to care and was newly activated (73%) or widely implemented (17%). 70% reported changes in DMT management. Interferons and glatiramer were considered safe. Dimethyl fumarate, teriflunomide and fingolimod were considered safe except for patients developing lymphopenia. No modifications were considered for natalizumab in 64%, cladribine in 24%, anti-CD20 in 22% and alemtuzumab in 17%; 18% (for alemtuzumab and cladribine) and 43% (for anti-CD20) considered postponing treatment. Conclusion: The ECTRIMS survey highlighted the challenges in keeping standards of care in clinical practice. Telemedicine clearly needs to be implemented. Gathering data on DMT safety will remain crucial to inform treatment decisions.

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