Vaccination and multiple sclerosis in the era of the COVID-19 pandemic

Monschein, Tobias; Hartung, Hans‐Peter; Zrzavy, Tobias; Barnett, Michael; Boxberger, Nina; Berger, Thomas; Chataway, Jeremy; Bar‐Or, Amit; Zettl, Uwe K.

doi:10.1136/jnnp-2021-326839

Cited by 29 publications

(38 citation statements)

References 38 publications

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“…Vaccinations protect against severe systemic infections and thus also against an associated worsening of the MS disease course. 31,32 Comparing our results internationally, we found similarities in the frequency of DMD use. A study of the Swedish MS Registry compared clinical and demographic data of 549 pediatriconset and 11,933 adult-onset PwMS with disease onset between 1975 and 2014.…”

Section: Discussionsupporting

confidence: 50%

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Treatment patterns in pediatric patients with multiple sclerosis in Germany—a nationwide claim-based analysis

Frahm¹,

Peters²,

Bätzing³

et al. 2021

Ther Adv Neurol Disord

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Background: The manifestation of multiple sclerosis (MS) in childhood and adolescence occurs in 3%−5% of all MS cases. However, the immunomodulatory and symptomatic treatment options in this population group are still limited. Objective: We aimed to elucidate the prescription frequency of medications used in pediatric patients with multiple sclerosis (PwMS) compared with the general population, considering the entire spectrum of medications prescribed. Methods: Based on nationwide outpatient drug prescription data and statutory health insurance (SHI) physicians’ claims data from 2018, we conducted a population-based cross-sectional study in Germany. Children and adolescents aged ⩽17 years ( n = 11,381,939) diagnosed with MS ( n = 613), and a matched (age, sex, and health insurance sector) control group ( n = 6130) were included. The prescription prevalence was measured as the proportion of MS patients with ⩾1 prescription. Results: Of the 613 pediatric PwMS with a median age of 16 years, 403 (65.7%) were female. For 15 out of the 18 different active agents analyzed, PwMS had a significantly higher prescription prevalence than the control group (Fisher’s exact test: p ⩽ 0.037). The most frequently prescribed drugs in PwMS were ibuprofen (28.4%; anti-inflammatory drug), cholecalciferol (23.0%; vitamin D3), and interferon beta-1a (21.5%; disease-modifying drug, DMD). The proportions of DMD prescriptions and antibiotic prescriptions were higher among PwMS aged 15–17 years than among those ⩽14 years (DMD: 43.4% vs 34.2%, p = 0.05; antibiotic: 34.1% vs 24.8%, p = 0.031). In contrast, younger PwMS were more likely to receive a prescription for anti-inflammatory/anti-rheumatic drugs (36.6% vs 26.5%, p = 0.02). Conclusion: Our study analyzing real-world medication data showed that interferon beta, anti-inflammatory drugs, and vitamins play an essential role in the treatment of pediatric PwMS. Future research should evaluate longitudinal treatment patterns of pediatric PwMS, paying particular attention to the time of diagnosis, time of first DMD initiation, and therapy switches.

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Section: Discussionsupporting

confidence: 50%

“…Vaccinations protect against severe systemic infections and thus also against an associated worsening of the MS disease course. 31,32…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns in pediatric patients with multiple sclerosis in Germany—a nationwide claim-based analysis

Frahm¹,

Peters²,

Bätzing³

et al. 2021

Ther Adv Neurol Disord

Self Cite

View full text Add to dashboard Cite

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“…The impact of treatments targeting the sphingosine 1-phosphate receptors (S1PR) expressed on lymphocytes is a matter of ongoing research as they reduce the egress of autoreactive T lymphocytes and their naïve progenitors from secondary lymphoid organs into the circulation. Notably, some immunotherapies approved for the treatment of MS attenuate the success of vaccinations [16]. Indeed, several reports corroborated that vaccination on treatment with S1PR modulators are associated with reduced seroconversion rates and attenuated responses [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 mRNA Vaccination in People with Multiple Sclerosis Treated with Fingolimod: Protective Humoral Immune Responses May Develop after the Preferred Third Shot

et al. 2022

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Evidence suggests limited development of protective IgG responses to mRNA-based vaccines in sphingosine-1-phosphate receptor (S1PR)-modulator treated individuals with multiple sclerosis (MS). We studied the extent of the humoral immune response after the preferred third mRNA SARS-CoV-2 vaccine in S1PR-modulator treated people with MS (pwMS) and insufficient IgG responses after the standard immunization scheme. Eight pwMS that were treated with fingolimod received a third homologous SARS-CoV-2 mRNA vaccine dose, either the Moderna’s mRNA-1273 or Pfizer-BioNTech’s BNT162b2 vaccine. We quantified the serum levels of IgG antibodies against the receptor-binding domain of SARS-CoV-2 four weeks later. An antibody titer of 100 AU/mL or more was considered protective. After the third vaccination, we found clinically relevant IgG titers in four out of eight individuals (50%). We conclude that the humoral immune response may reach protective levels after the third preferred dose of the homologous SARS-CoV-2 mRNA vaccine. Vaccine shots in S1PR-modulator treated pwMS ahead of schedule may be a strategy to overcome insufficient humoral immune responses following the standard vaccination scheme.

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“…However, certain DMDs, including Ocrelizumab and Fingolimod, may reduce the efficacy of COVID-19 vaccines [11]. Since vaccination has been approved as an effective and acceptable approach for controlling COVID-19 [12,13] and also as infectious diseases may increase the risk of disease progression in MS patients and result in reduced life expectancy [14]. COVID-19 vaccination has started in Iran since May 2021 [15].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccination Willingness and Acceptability in Multiple Sclerosis Patients: A Cross Sectional Study in Iran

Nabavi

Mehrabani²,

Ghalichi

et al. 2022

Vaccines

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Multiple sclerosis (MS) is a chronic, predominantly immune-mediated degenerative disease of the central nervous system. Due to prolonged use of immunomodulatory and immunosuppressive medications, vaccine hesitancy could be common among MS patients. Our main aim in the current study was to evaluate the willingness and acceptability of COVID-19 vaccination in patients with MS. In our multicenter cross-sectional questionnaire-based clinical study, 892 patients completed the questionnaire between May to June 2021. The questionnaire consisted of demographic data, MS disease-related factors, history of COVID-19 infection/vaccination, and any existing comorbidities. Statistical analysis was performed using SPSS software version 19. Overall, 68% of the participants expressed willingness to be vaccinated. Major causes of vaccine refusal in our patients were the fear of reducing the efficacy of disease modifying drugs (DMDs) upon vaccination as well as distrusting the vaccines and overestimation bias in the power of their innate immunity and potential COVID-19 resistance. Some demographic factors affected vaccination enthusiasm in our study. Our findings did not show significant correlation between the age and comorbidity and vaccine willingness. Only one-third of our patients received their vaccine information from healthcare providers. The majority of them received these data from official broadcasting channels and social media. However, despite several concerns, the willingness of COVD-19 vaccination in the Iranian MS patients is remarkable.

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Vaccination and multiple sclerosis in the era of the COVID-19 pandemic

Cited by 29 publications

References 38 publications

Treatment patterns in pediatric patients with multiple sclerosis in Germany—a nationwide claim-based analysis

Treatment patterns in pediatric patients with multiple sclerosis in Germany—a nationwide claim-based analysis

SARS-CoV-2 mRNA Vaccination in People with Multiple Sclerosis Treated with Fingolimod: Protective Humoral Immune Responses May Develop after the Preferred Third Shot

COVID-19 Vaccination Willingness and Acceptability in Multiple Sclerosis Patients: A Cross Sectional Study in Iran

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