Approach to SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis

Abstract

For more than a year now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been causing the coronavirus disease (COVID-19) pandemic with high mortality and detrimental effects on society, economy, and individual lives. Great hopes are being placed on vaccination as one of the most potent escape strategies from the pandemic and multiple vaccines are already in clinical use. However, there is still a lot of insecurity about the safety and efficacy of vaccines in patients with autoimmune diseases like multiple sclerosis (MS), especially under treatment with immunomodulatory or immunosuppressive drugs. We propose strategic approaches to SARS-CoV-2 vaccination management in MS patients and encourage fellow physicians to measure the immune response in their patients. Notably, both humoral and cellular responses should be considered since the immunological equivalent for protection from SARS-CoV-2 after infection or vaccination still remains undefined and will most likely involve antiviral cellular immunity. It is important to gain insights into the vaccine response of immunocompromised patients in order to be able to deduce sensible strategies for vaccination in the future.

Multiple Sclerosis and SARS-CoV-2: Has the Interplay Started?

“…It is known that some DMTs can negatively affect active immunization. Evidence recently reviewed in (167) indicates that fingolimod, natalizumab, alemtuzumab, and the anti-CD20 monoclonal antibodies (ocrelizumab, rituximab) may reduce serological response to "traditional" vaccines (inactivated, conjugate, toxoid). As presumable and in line with studies on rheumatic diseases, anti-CD20 appears to have the greatest impact on antibody production, which is partly related to the levels of circulating B cells at the time of administration (168).…”

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

“…3 However, as a result of immunomodulatory effects or depletion of circulating lymphocytes, MS disease-modifying therapies (DMTs) may reduce humoral or cellular immune responses to vaccines, including against SARS-CoV-2. 1,4,5 Although the clinical significance of these varying responses, including the impact on risk of infection, is not fully understood, the COVID-19 pandemic makes better characterization of how MS DMTs influence vaccine effectiveness critically important. 1,4,5 Limited data relating to the efficacy of COVID-19 vaccines in DMT-treated PwMS have led to varying vaccination guidelines from MS organizations.…”

Acute cerebellitis requiring posterior fossa decompression after COVID-19 vaccination in an ocrelizumab-treated patient with multiple sclerosis

“…Vaccination against COVID-19 is highly recommended for patients with multiple sclerosis (MS), especially those treated with anti-B-cell therapies [ 1 ]. The incidence of neurological complications of COVID-19 vaccines in the general population seems to be comparable with other vaccines (e.g., against influenza…) [ 2 , 3 ].…”