COVID-19 vaccine response in people with multiple sclerosis.

Abstract

OBJECTIVE\nTo investigate the effect of disease modifying therapies on immune response to SARS-CoV2 vaccines in people with multiple sclerosis.\n\n\nMETHODS\n473 people with multiple sclerosis provided one or more dried blood spot samples. Information about COVID-19 and vaccine history, medical and drug history were extracted from questionnaires and medical records. Dried blood spots were eluted and tested for antibodies to SARS-CoV2. Antibody titres were partitioned into tertiles with people on no disease modifying therapy as a reference. We calculated the odds ratio of seroconversion (univariate logistic regression) and compared quantitative vaccine response (Kruskal Wallis) following SARS-CoV2 vaccine according to disease modifying therapy. We used regression modelling to explore the effect of vaccine timing, treatment duration, age, vaccine type and lymphocyte count on vaccine response.\n\n\nRESULTS\nCompared to no disease modifying therapy, the use of anti-CD20 monoclonal antibodies (odds ratio 0.03; 95% confidence interval 0.01-0.06, p<0.001) and fingolimod (odds ratio 0.04; 95% confidence interval 0.01-0.12) were associated with lower seroconversion following SARS-CoV2 vaccine. All other drugs did not differ significantly from the untreated cohort. Both time since last anti-CD20 treatment and total time on treatment were significantly associated with response to vaccination. Vaccine type significantly predicted seroconversion, but not in those on anti-CD20 medications. Preliminary data on cellular T-cell immunity showed 40% of seronegative subjects had measurable anti-SARS-CoV2 T cell responses.\n\n\nINTERPRETATION\nSome disease modifying therapies convey risk of attenuated serological response to SARS-CoV2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. This article is protected by copyright. All rights reserved.