Seroconversion after COVID-19 vaccination for multiple sclerosis patients on high efficacy disease modifying medications

Levit, Elle; Longbrake, Erin E.; Stoll, Sharon

doi:10.1016/j.msard.2022.103719

Cited by 11 publications

(10 citation statements)

References 22 publications

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“…As expected of B-cell depleting therapy [ 21 , 22 ], we found that most o-pwMS did not develop the antibody response to mRNA-based vaccines [ 2 , 10 ], although we found that the seroconversion rate of o-pwMS is overall quite high compared to other works [ 8 , 9 ]. However, it is worth noting that this result is in line with a recent study, which shows a similar seroconversion rate [ 23 ]. In addition, o-pwMS who developed antibodies had significantly lower antibody titers compared to c-pwMS and f-pwMS, as shown in previous works [ 8 , 18 ], although several subjects showed high antibody titers.…”

Section: Discussionsupporting

confidence: 92%

Immune Response after COVID-19 mRNA Vaccination in Multiple Sclerosis Patients Treated with DMTs

Mazziotti

Crescenzo²,

Tamanti

et al. 2022

Biomedicines

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The impact of disease-modifying therapies (DMTs) on the immune response to coronavirus disease-2019 (COVID-19) vaccines in persons with multiple sclerosis (pwMS) needs further elucidation. We investigated BNT162b2 mRNA COVID-19 vaccine effects concerning antibody seroconversion, inflammatory mediators’ level and immunophenotype assessment in pwMS treated with cladribine (c-pwMS, n = 29), fingolimod (f-pwMS, n = 15) and ocrelizumab (o-pwMS, n = 54). Anti-spike immunoglobulin (Ig)-G detection was performed by an enzyme immunoassay; molecular mediators (GrB, IFN-γ and TNF-α) were quantified using the ELLA platform, and immunophenotype was assessed by flow cytometry. ANCOVA, Student’s t-test and Pearson correlation analyses were applied. Only one o-pwMS showed a mild COVID-19 infection despite most o-pwMS lacking seroconversion and showing lower anti-spike IgG titers than c-pwMS and f-pwMS. No significant difference in cytokine production and lymphocyte count was observed in c-pwMS and f-pwMS. In contrast, in o-pwMS, a significant increase in GrB levels was detected after vaccination. Considering non-seroconverted o-pwMS, a significant increase in GrB serum levels and CD4+ T lymphocyte count was found after vaccination, and a negative correlation was observed between anti-spike IgG production and CD4+ T cells count. Differences in inflammatory mediators’ production after BNT162b2 vaccination in o-pwMS, specifically in those lacking anti-spike IgG, suggest a protective cellular immune response.

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Section: Discussionsupporting

confidence: 92%

Immune Response after COVID-19 mRNA Vaccination in Multiple Sclerosis Patients Treated with DMTs

Mazziotti

Crescenzo²,

Tamanti

et al. 2022

Biomedicines

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“…According to a retrospective chart review, seroconversion for SARS-CoV-2 neutralizing antibodies is impaired in MS patients receiving anti-CD20 antibodies, with lower seroconversion rates with rituximab and ocrelizumab compared to ofatumumab [ 10 ]. In line with these retrospective results, it has recently been shown in a prospective setting that ofatumumab-treated patients respond to initial vaccination against SARS-CoV-2 and while neutralizing antibody titers were reduced under ofatumumab, T-cell response was not affected [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Results on SARS-CoV-2 mRNA Vaccine Booster from an Open-Label Multicenter Study in Ofatumumab-Treated Participants with Relapsing Multiple Sclerosis

et al. 2023

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Background: Few data exist on how ofatumumab treatment impacts SARS-CoV-2 booster vaccination response. Methods: KYRIOS is an ongoing prospective open-label multicenter study on the response to initial and booster SARS-CoV-2 mRNA vaccination before or during ofatumumab treatment in relapsing MS patients. The results on the initial vaccination cohort have been published previously. Here, we describe 23 patients who received their initial vaccination outside of the study but booster vaccination during the study. Additionally, we report the booster results of two patients in the initial vaccination cohort. The primary endpoint was SARS-CoV-2-specific T-cell response at month 1. Furthermore, serum total and neutralizing antibodies were measured. Results: The primary endpoint was reached by 87.5% of patients with booster before (booster cohort 1, N = 8) and 46.7% of patients with booster during ofatumumab treatment (booster cohort 2, N = 15). Seroconversion rates for neutralizing antibodies increased from 87.5% at baseline to 100.0% at month 1 in booster cohort 1 and from 71.4% to 93.3% in booster cohort 2. Of note, 3 of 4 initially seronegative patients in booster cohort 2 and one seronegative patient in the initial vaccination cohort seroconverted after the booster during ofatumumab treatment. Conclusions: Booster vaccinations increase neutralizing antibody titers in ofatumumab-treated patients. A booster is recommended in ofatumumab-treated patients.

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“…Patients with MS and related neuroinflammatory conditions receiving anti-CD20 therapies are at an increased risk of infections and impaired responses to vaccinations ( Bar-Or et al, 2020 ; Krajnc et al, 2022 ). Accordingly, concerns about the implications of limited seroconversion in patients treated with anti-CD20 therapies following COVID-19 vaccination have been reported ( Bar-Or et al, 2020 ; Cross et al, 2022 ; Georgieva et al, 2022 ; Iannetta et al, 2021 ; Levit et al, 2022 ; Smets et al, 2021 ; Tallantyre et al, 2022 ). However, there is currently less information available regarding seroconversion in patients treated with anti-CD20 therapies following natural infection, largely owing to the inability to distinguish severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein seropositivity due to vaccination from natural infection.…”

Section: Introductionmentioning

confidence: 99%

“…However, there is currently less information available regarding seroconversion in patients treated with anti-CD20 therapies following natural infection, largely owing to the inability to distinguish severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein seropositivity due to vaccination from natural infection. More information on the implications of treatment with anti-CD20 therapy on vaccination responses and outcomes is needed to inform and develop effective management strategies for patients with MS and related neuroinflammatory conditions, and to help to address heightened anxieties regarding possible attenuated vaccine responses ( Baker et al, 2020 ; Levit et al, 2022 ). This retrospective analysis evaluated qualitative and quantitative seroconversion rates in patients treated with anti-CD20 therapies, comparing responses following vaccination with responses following natural infection.…”

Section: Introductionmentioning

confidence: 99%

A retrospective evaluation of seroconversion after COVID-19 during the early Omicron wave in fully vaccinated multiple sclerosis patients receiving anti-CD20 therapies

Stoll¹,

Desai²,

Levit³

2023

Multiple Sclerosis and Related Disorders

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Seroconversion after COVID-19 vaccination for multiple sclerosis patients on high efficacy disease modifying medications

Cited by 11 publications

References 22 publications

Immune Response after COVID-19 mRNA Vaccination in Multiple Sclerosis Patients Treated with DMTs

Immune Response after COVID-19 mRNA Vaccination in Multiple Sclerosis Patients Treated with DMTs

Results on SARS-CoV-2 mRNA Vaccine Booster from an Open-Label Multicenter Study in Ofatumumab-Treated Participants with Relapsing Multiple Sclerosis

A retrospective evaluation of seroconversion after COVID-19 during the early Omicron wave in fully vaccinated multiple sclerosis patients receiving anti-CD20 therapies

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