Impact of vaccination on COVID‐19 outcome in multiple sclerosis

Abstract

Background and purpose COVID‐19 continues to challenge neurologists in counseling persons with multiple sclerosis (pwMS) regarding disease‐modifying treatment (DMT) and vaccination. The objective here was to characterize predictors of COVID‐19 outcome in pwMS. Methods We included pwMS with polymerase chain reaction‐confirmed COVID‐19 diagnosis from a nationwide population‐based registry. COVID‐19 outcome was classified as either mild or severe. Impact of DMT, specifically anti‐CD20 monoclonal antibodies (anti‐CD20), and vaccination on COVID‐19 outcome was determined by multivariate models adjusted for a priori risk (determined by a cumulative risk score comprising age, disability, and comorbidities). Results Of 317 pwMS with COVID‐19 (mean age = 41.8 years [SD = 12.4], 72.9% female, median Expanded Disability Status Scale = 1.5 [range = 0–8.5], 77% on DMT [16% on anti‐CD20]), 92.7% had a mild course and 7.3% a severe course, with 2.2% dying from COVID‐19. Ninety‐seven pwMS (30.6%) were fully vaccinated. After a median 5 months from vaccination to SARS‐CoV‐2 infection (range = 1–9), severe COVID‐19 occurred in 2.1% of fully vaccinated pwMS compared to 9.5% in unvaccinated pwMS ( p = 0.018). A priori risk robustly predicted COVID‐19 severity ( R 2 = 0.605, p < 0.001). Adjusting for a priori risk, anti‐CD20 treatment was associated with increased COVID‐19 severity (odds ratio [OR] = 3.3, R 2 = 0.113, p = 0.003), but exposure to any other DMT was not. Fully vaccinated pwMS showed a significantly decreased risk for severe COVID‐19 (OR = 0.21, R 2 = 0.144, p < 0.001). Conclusions In a population‐based MS cohort, COVID‐19 course is primarily predicted by a priori risk (depending on age, disability, and comorbidities) explaining about 60% of variance. Anti‐CD20 treatment is associated with a moderately increased risk, whereas reassuringly vaccination provides protection from severe COVID‐19.

Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis

“…These findings are in line with recent observations from the Austrian MS-COVID-19 investigators who reported a significantly decreased risk for severe illness after developing COVID-19 (defined as the clinical status at the most severe point requiring hospitalization and additionally meeting at least 1 of 5 prespecified and objective respiratory distress criteria) in fully vaccinated patients with MS (OR 0.21). 41 Hesitancy and/or unwillingness to receive vaccination against SARS-CoV-2 ranges between 15% and 30% in patients with MS and is often instilled by safety concerns, despite the fact that the current literature does not show an increased risk for reactogenicity, serious adverse events, or relapse activity. 24 , 25 Our cohort presented with a lower coverage rate, but data collection started well before the rollout of the vaccination campaign in Belgium.…”

COVID-19 severity among patients with multiple sclerosis treated with cladribine: A systematic review and meta-analysis

“…Of the remaining 114, 7 were selected for the final analysis, along with 6 retrieved out from search strategy (Figure 1). References of 13 selected manuscripts 6,7,9,16,17,18,19,20,21,22,23,24 are shown in Table 1.…”

T cell responses to SARS-CoV-2 vaccination in people with multiple sclerosis differ between disease-modifying therapies

“…However, the severity of these infections is still unclear, and where cases could be followed on an individual level, there were no deaths from COVID-19 (42, 43). Further research has found that, even after vaccination, pwMS on anti-CD20 drugs were at higher risk of hospitalisation but not death; this risk was not seen with other DMTs including S1PR modulators (44). In our study, 29 individuals across all DMTs contracted SARS-CoV-2 after vaccination and none of these were hospitalised or died.…”