scholarly journals Inadequate Vaccine Responses in Children With Multiple Sclerosis

2021 ◽  
Vol 9 ◽  
Author(s):  
Jonathan D. Santoro ◽  
Laura E. Saucier ◽  
Runi Tanna ◽  
Sarah E. Wiegand ◽  
Dania Pagarkar ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vaccine Response ◽  
Control Data ◽  
Institutional Control ◽  
Varicella Zoster ◽  
Vaccine Responses ◽  
Disease Modifying Therapy ◽  
Chi Squared ◽  
Antibody Titers ◽  
Disease Modifying

Objective: Immunizations against Hepatitis B virus (HBV) and Varicella Zoster virus (VZV), are recommended for patients with pediatric onset multiple sclerosis (POMS) and may be required prior to initiation of some disease modifying therapies. However, the efficacy of routine vaccine administration in POMS has never been studied. We sought to assess the humoral mediated vaccine response to HBV and VZV in children with POMS.Methods: A multi-center retrospective chart-based review of 62 patients with POMS was performed. Clinical data and antibody titers against HBV and VZV were collected prior to initiation of disease modifying therapy or steroids and compared to institutional control data, using t-test and chi squared analysis.Results: There were low rates of immunity against both HBV and VZV (33 and 25% respectively) among individuals with POMS. Fifteen individuals (24%) were non-immune to both. Compared to institutional control data, individuals with POMS were significantly less likely to be immune to and HBV (p = 0.003, 95% CI: 0.22–0.75) and VZV (p < 0.001, 95% CI: 0.09–0.39).Interpretation: Individuals with POMS have low rates of antibody-mediated immunity against HBV and VZV, despite receiving the appropriate vaccinations. This suggests an association between POMS and systemic immune dysregulation although further study is 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 Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis

Neurology ◽  
2016 ◽  
Vol 86 (14) ◽  
pp. 1287-1295 ◽  
Author(s):  
Tingting Zhang ◽  
Helen Tremlett ◽  
Stella Leung ◽  
Feng Zhu ◽  
Elaine Kingwell ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Modifying Therapy ◽  
Disease Modifying

Adherence of Adolescents to Multiple Sclerosis Disease-Modifying Therapy

2009 ◽  
Vol 41 (2) ◽  
pp. 119-123 ◽  
Author(s):  
Jennifer E. Thannhauser ◽  
Jean K. Mah ◽  
Luanne M. Metz
Keyword(s):  
Multiple Sclerosis ◽  
Disease Modifying Therapy ◽  
Multiple Sclerosis Disease ◽  
Disease Modifying

scholarly journals Stopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis

2017 ◽  
Vol 19 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Gary Birnbaum
Keyword(s):  
Multiple Sclerosis ◽  
Acute Disease ◽  
Published Data ◽  
Secondary Progressive ◽  
Disease Modifying Therapy ◽  
Scale Scores ◽  
Group A ◽  
Multiple Variables ◽  
Disease Modifying ◽  
Group B

Background: Current disease-modifying therapies (DMTs) are of benefit only in people with relapsing forms of multiple sclerosis (RMS). Thus, safely stopping DMTs in people with secondary progressive MS may be possible. Methods: Two groups of patients with MS were studied. Group A consisted of 77 patients with secondary progressive MS and no evidence of acute central nervous system inflammation for 2 to 20 years. These patients were advised to stop DMTs. Group B consisted of 17 individuals with RMS who stopped DMTs on their own. Both groups were evaluated at treatment cessation and for a minimum of 1 year thereafter. Multiple variables were assessed to determine those that predicted recurrent acute disease. Results: Nine patients in group A (11.7%) and ten patients in group B (58.8%) had recurrent acute disease, almost always within 1 to 2 years of stopping treatment. The only variable of significance in group A distinguishing stable and relapsing patients was age (P = .0003), with relapsing patients being younger. Group B patients were younger and had significantly lower Expanded Disability Status Scale scores than group A, with no significant differences in age between relapsed and stable patients. Conclusions: The DMTs can be stopped safely in older patients with MS (≥7 decades) with no evidence of acute disease for 2 years or longer, with an almost 90% probability of remaining free of acute recurrence. The high proportion of untreated patients with RMS experiencing recurrent acute disease is consistent with published data.

scholarly journals Incidence of malignancy in multiple sclerosis: A cohort study in the Danish Multiple Sclerosis Registry

2021 ◽  
Vol 7 (4) ◽  
pp. 205521732110539
Author(s):  
Mette Nørgaard ◽  
Katalin Veres ◽  
Finn T Sellebjerg ◽  
Lise S Svingel ◽  
Caroline Foch ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Skin Cancer ◽  
General Population ◽  
Incidence Rates ◽  
Disease Modifying Therapy ◽  
Non Melanoma Skin Cancer ◽  
General Population Cohort ◽  
Disease Modifying ◽  
Rate Ratios ◽  
Melanoma Skin

Background The association between multiple sclerosis and malignancy is controversial and a current appraisal is needed. Objective To determine the incidence of malignancy in patients with multiple sclerosis compared with the general population and in relation to disease-modifying therapy. Methods Patients with multiple sclerosis (1995 – 2015) were matched by birth year and sex to individuals without multiple sclerosis in the general population. Patients with multiple sclerosis initiating disease-modifying therapy were evaluated using landmark period analysis. Malignancy risk was assessed by incidence rates, incidence rate ratios, and standardised incidence ratios. Results The standardised incidence ratio of any malignancy (excluding non-melanoma skin cancer) in patients with multiple sclerosis ( n = 10,557) was 0.96 (95% CI 0.88 – 1.06), and there was no increased incidence of specific malignancy types compared with the general population cohort ( n = 103,761). At the 48-month landmark period, the age-adjusted incidence per 100,000 person-years of any malignancy (excluding non-melanoma skin cancer) was 436.7 (95% CI 361.0 – 512.4) in patients newly treated with immunomodulator-only and 675.1 (95% CI 130.4 – 1219.9) in patients newly treated with immunosuppressant-only. Conclusions There was no increased incidence of malignancy overall or by type in patients with multiple sclerosis compared neither with the general population nor in relation to disease-modifying therapy.

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