The humoral response to SARS-COV-2 vaccines in MS patients: A case series exploring the impact of DMT, lymphocyte count, immunoglobulins, and vaccine type

Jakubecz, Collin; Zhang, Xiaochun Susan; Woodson, Sophia; Serra, Alessandro; Abboud, Hesham

doi:10.1016/j.msard.2022.103785

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…The failure to mount a humoral response to SARS-CoV-2 vaccination with anti-CD20 therapies is likely due to the mode of action of this class of DMTs. In contrast, the humoral response to SARS-CoV-2 vaccination appears to be well preserved in people with MS treated with fumarates [19,53].…”

Section: Discussionmentioning

confidence: 89%

“…Should de-escalation be considered as a result of concerns of immune deficiency, infection risk, impaired vaccine response, immunosenescence or other factors, a DMT from the fumarates class may be an alternative option for disease control. The benefits include a potential reduced risk of infections [8] and improved ability to mount antibody responses to both infections and vaccines compared with B cell-depleting therapies [18,19]. In addition, a de-escalation strategy may offer the potential for better disease control in some patients compared to DMT discontinuation.…”

Section: Introductionmentioning

confidence: 99%

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De-escalation of Disease-Modifying Therapy for People with Multiple Sclerosis Due to Safety Considerations: Characterizing 1-Year Outcomes in 25 People Who Switched from Ocrelizumab to Diroximel Fumarate

Gudesblatt,

Bumstead,

Buhse

et al. 2024

Adv Ther

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Introduction Switching disease-modifying therapy (DMT) may be considered for relapsing–remitting multiple sclerosis (RRMS) if a patient’s current therapy is no longer optimal. This was particularly important during the recent COVID-19 pandemic because of considerations around immune deficiency and impaired vaccine response associated with B cell-depleting DMTs. This real-world, single-center study aimed to evaluate change or decline in functional ability and overall disease stability in people with RRMS who were switched from B cell-depleting ocrelizumab (OCRE) to diroximel fumarate (DRF) because of safety concern related to the COVID-19 pandemic. Methods Adults with RRMS were included if they had been clinically stable for ≥ 1 year on OCRE. Data collected at baseline and 1 year post switch included relapse rate, magnetic resonance imaging (MRI), blood work for assessment of peripheral immune parameters, the Cognitive Assessment Battery (CAB), optical coherence tomography (OCT), and patient-reported outcomes (PROs). Results Participants ( N = 25) had a mean (SD) age of 52 (9) years, and a mean (SD) duration of 26 (8) months’ treatment with OCRE before the switch to DRF. Median washout duration since the last OCRE infusion was 7 months (range 4–18 months). No participants relapsed on DRF during follow-up, and all remained persistent on DRF after 1 year. There were no significant changes in peripheral immune parameters, other than an increase in the percentage of CD19 + cells 1 year after switching ( p < 0.05). Similarly, there were no significant changes in CAB, OCT, and PROs. Conclusion These preliminary findings suggest that transition to DRF from OCRE may be an effective treatment option for people with RRMS who are clinically stable but may need to switch for reasons unrelated to effectiveness. Longer follow-up times on larger samples are needed to confirm these observations. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-024-02902-0.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

De-escalation of Disease-Modifying Therapy for People with Multiple Sclerosis Due to Safety Considerations: Characterizing 1-Year Outcomes in 25 People Who Switched from Ocrelizumab to Diroximel Fumarate

Gudesblatt,

Bumstead,

Buhse

et al. 2024

Adv Ther

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“…GC exerts multiple actions on lymphocytes by controlling differentiation, migration, polarization into IFNγ producing TH1 cells, memory T cell formation, while regulatory T cells are increased ( 19 ). Other studies conducted in ISD patients have shown qualitative and quantitative decreases in the COVID-19 humoral response [ 3 , 20 ]. In contrast, T cell responses on GC treated patients have been described only in small cohorts of patients.…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoid use as a cause of non-cellular immune response to SARS-Cov2 Spike in patients with immune system diseases

Renaudineau¹,

Sailler²,

Abravanel³

et al. 2022

Journal of Autoimmunity

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“…Analogously, the humoral and cellular responses to vaccines have been investigated in pwMS with encouraging findings of effective vaccinal protection, with the exception of pwMS on anti-CD20 therapies, which are therapies specifically targeting BN lymphocytes [29]. As expected, these patients have markedly reduced antibody production, but vaccination does produce a preserved cellular-mediated immunological response [27,[30][31][32][33][34].…”

Section: Introductionmentioning

confidence: 95%

The Potential Role of SARS-CoV-2 Infection and Vaccines in Multiple Sclerosis Onset and Reactivation: A Case Series and Literature Review

Pichiecchio

Colombo²,

Rigoni³

et al. 2023

Viruses

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The recent SARS-CoV-2 pandemic and related vaccines have raised several issues. Among them, the potential role of the viral infection (COVID-19) or anti-SARS-CoV-2 vaccines as causal factors of dysimmune CNS disorders, as well as the safety and efficacy of vaccines in patients affected by such diseases and on immune-active treatments have been analyzed. The aim is to better understand the relationship between SARS-CoV-2 infection/vaccines with dysimmune CNS diseases by describing 12 cases of multiple sclerosis/myelitis onset or reactivation after exposure to SARS-CoV-2 infection/vaccines and reviewing all published case reports or case series in which MS onset or reactivation was temporally associated with either COVID-19 (8 case reports, 3 case series) or anti-SARS-CoV-2 vaccines (13 case reports, 6 case series). All the cases share a temporal association between viral/vaccine exposure and symptoms onset. This finding, together with direct or immune-based mechanisms described both during COVID-19 and MS, claims in favor of a role for SARS-CoV-2 infection/vaccines in unmasking dysimmune CNS disorders. The most common clinical presentations involve the optic nerve, brainstem and spinal cord. The preferential tropism of the virus together with the presence of some host-related genetic/immune factors might predispose to the involvement of specific CNS districts.

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The humoral response to SARS-COV-2 vaccines in MS patients: A case series exploring the impact of DMT, lymphocyte count, immunoglobulins, and vaccine type

Cited by 8 publications

References 17 publications

De-escalation of Disease-Modifying Therapy for People with Multiple Sclerosis Due to Safety Considerations: Characterizing 1-Year Outcomes in 25 People Who Switched from Ocrelizumab to Diroximel Fumarate

De-escalation of Disease-Modifying Therapy for People with Multiple Sclerosis Due to Safety Considerations: Characterizing 1-Year Outcomes in 25 People Who Switched from Ocrelizumab to Diroximel Fumarate

Glucocorticoid use as a cause of non-cellular immune response to SARS-Cov2 Spike in patients with immune system diseases

The Potential Role of SARS-CoV-2 Infection and Vaccines in Multiple Sclerosis Onset and Reactivation: A Case Series and Literature Review

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