Humoral response to SARS-CoV-2 COVID-19 vaccines in patients with multiple sclerosis treated with immune reconstitution therapies

Abstract

The aim of our investigation was to evaluate the humoral response to natural SARS-CoV-2 infection and to two COVID-19 vaccines (BNT162b2 Pfizer-BioNTech and Beijing/Sinopharm BBIBP-CorV) in our cohort of PwMS under high efficacy disease modifying therapies (DMTs), cladribine and alemtuzumab. Methods: Twenty two PwMS treated at the Clinic of Neurology, in Belgrade, who developed COVID-19 and/or were vaccinated against SARS-CoV-2, during treatment with cladribine and alemtuzumab, were included. Out of 18 patients treated with cladribine, 11 developed COVID-19, and 11 were vaccinated against SARS-CoV-2 (four with mRNA vaccine, 7 with Sinopharm). Four MS patients under alemtuzumab were vaccinated against SARS-CoV-2; three with mRNA, and one with Sinopharm vaccine. SARS-Cov-2 IgG response was measured using ELISA anti-spike protein-based serology (INEP, Belgrade, Serbia). Results: All 7 patients under cladribine treatment who suffered from COVID-19, developed IgG antibodies, 2.0-5.5 months after last symptoms. All four (100%) patients under cladribine who were vaccinated with Pfizer-BioNTech vaccine, and three out of seven (42.9%) vaccinated with Sinopharm, developed antibodies. All 4 patients under alemtuzumab developed antibodies after vaccination. In all cases, seroprotection occurred, irrespective of timing of vaccination and absolute lymphocyte count. Conclusion: Our findings in a small number of highly active PwMS in whom, lymphodepleting, immune reconstitution therapies, were applied in order to successfully manage MS, indicate that in a number of these patients it was possible to develop at the same time seroprotection in these patients after COVID-19 vaccination in these complex circumstances.

Effect of cladribine on COVID-19 serology responses following two doses of the BNT162b2 mRNA vaccine in patients with multiple sclerosis

“…In regards to the SARS-CoV-2 vaccine, 100% positive serology response was described by Buttari et al ( Buttari et al, 2021 ) and Drulovic ( Drulovic et al, 2021 ), in 2 and 4 cladribine treated patients and by Achiron et al, in 23 MS patients treated with cladribine. ( Achiron et al, 2021 ) In our study like in the above studies, no correlation was found between SARS-CoV-2 IgG titer and lymphocyte counts in cladribine-treated patients.…”

“…( Louapre et al, 2020 , Salter et al, 2021 ) With widespread administration of the vaccines for COVID-19, concerns have been raised related to the possibility of an inadequate immune response to vaccination in MS patients and especially MS treated with high-efficacy DMTs. ( Achiron et al, February 2021 , Ciotti et al, 2020 ) The effects of MS treatments on immune responses to mRNA vaccine have not yet been widely reported ( Achiron et al, 2021 , Buttari et al, 2021 , Drulovic et al, 2021 )…”

Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review

“…Thirteen studies included patients who received the vaccine developed by Janssen (Ad26.COV2.S) [ [25] , [26] , [27] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ], nine included patients vaccinated with the AstraZeneca vaccine (ChAdOx1) [ [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] ], three included patients receiving the CoronaVac vaccine (Sinovac Biotech) [ [50] , [51] , [52] ], and one randomized controlled trial evaluated the vaccine developed by Novavax (NVX-CoV2373) vaccine [ 53 ]. One study included patients receiving the BBV152-Covaxin (Bharat Biotech) vaccine [ 44 ] and one included patients receiving the BBIBP-CorV (Sinopharm) vaccine [ 54 ].…”

Einblicke in die Behandlung der Multiplen Sklerose mit Cladribin-Tabletten seit Beginn der COVID-19-Pandemie

“…Weitere Hinweise für Unterschiede in der humoralen Immunantwort nach SARS-CoV-2-Impfung lieferten Untersuchungen der Belgrader Kohorte [ 34 ]. Es wurden 11 MS-Erkrankte unter Cladribin-Tabletten gegen SARS-CoV geimpft, hiervon waren zuvor 4 an COVID-19 erkrankt.…”

“…Vier Tage nach dem Abschluss der 2. Einnahmephase der Cladribin-Tabletten im ersten Jahr erkrankte der Ehemann der ersten Patientin (29 Jahre, EDSS 2) an COVID- In eine Kohortenstudie aus Belgrad wurden 18 MS-Erkrankte, die mit Cladribin-Tabletten behandelt wurden, eingeschlossen (mittleres Alter 42 Jahre, mittlere Krankheitsdauer 14 Jahre und medianerEDSS3 Punkte) [34]. Hierunter erkrankten 11 (61 %) an COVID-19, der mittlere Abstand zur letzten Cladribin-Tabletteneinnahme betrug 3,7 Monate (Spanne 1-6,5).…”