COVID‐19 Vaccine Response in People with Multiple Sclerosis
Objective The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines in people with multiple sclerosis (MS). Methods Four hundred seventy‐three people with MS provided one or more...
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| Published in | Annals of neurology Vol. 91; no. 1; pp. 89 - 100 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken, USA
John Wiley & Sons, Inc
01.01.2022
Wiley Subscription Services, Inc |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Objective
The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines in people with multiple sclerosis (MS).
Methods
Four hundred seventy‐three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (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‐CoV‐2. Antibody titers 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 the SARS‐CoV‐2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response.
Results
Compared to no disease modifying therapy, the use of anti‐CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01–0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01–0.12) were associated with lower seroconversion following the SARS‐CoV‐2 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 the response to the vaccination. The 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‐CoV‐2 T cell responses.
Interpretation
Some disease modifying therapies convey risk of attenuated serological response to SARS‐CoV‐2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a–n/a |
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| AbstractList | The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines in people with multiple sclerosis (MS).
Four hundred seventy-three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (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-CoV-2. Antibody titers 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 the SARS-CoV-2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response.
Compared to no disease modifying therapy, the use of anti-CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01-0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01-0.12) were associated with lower seroconversion following the SARS-CoV-2 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 the response to the vaccination. The 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-CoV-2 T cell responses.
Some disease modifying therapies convey risk of attenuated serological response to SARS-CoV-2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a-n/a. Objective The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines in people with multiple sclerosis (MS). Methods Four hundred seventy‐three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (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‐CoV‐2. Antibody titers 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 the SARS‐CoV‐2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response. Results Compared to no disease modifying therapy, the use of anti‐CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01–0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01–0.12) were associated with lower seroconversion following the SARS‐CoV‐2 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 the response to the vaccination. The 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‐CoV‐2 T cell responses. Interpretation Some disease modifying therapies convey risk of attenuated serological response to SARS‐CoV‐2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a–n/a Objective The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines in people with multiple sclerosis (MS). Methods Four hundred seventy‐three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (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‐CoV‐2. Antibody titers 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 the SARS‐CoV‐2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response. Results Compared to no disease modifying therapy, the use of anti‐CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01–0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01–0.12) were associated with lower seroconversion following the SARS‐CoV‐2 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 the response to the vaccination. The 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‐CoV‐2 T cell responses. Interpretation Some disease modifying therapies convey risk of attenuated serological response to SARS‐CoV‐2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a–n/a The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines in people with multiple sclerosis (MS).OBJECTIVEThe purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines in people with multiple sclerosis (MS).Four hundred seventy-three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (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-CoV-2. Antibody titers 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 the SARS-CoV-2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response.METHODSFour hundred seventy-three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (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-CoV-2. Antibody titers 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 the SARS-CoV-2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response.Compared to no disease modifying therapy, the use of anti-CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01-0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01-0.12) were associated with lower seroconversion following the SARS-CoV-2 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 the response to the vaccination. The 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-CoV-2 T cell responses.RESULTSCompared to no disease modifying therapy, the use of anti-CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01-0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01-0.12) were associated with lower seroconversion following the SARS-CoV-2 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 the response to the vaccination. The 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-CoV-2 T cell responses.Some disease modifying therapies convey risk of attenuated serological response to SARS-CoV-2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a-n/a.INTERPRETATIONSome disease modifying therapies convey risk of attenuated serological response to SARS-CoV-2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 20219999:n/a-n/a. |
| Author | Kang, Angray S. Godkin, Andrew Harding, Katharine E. Evangelou, Nikos Chance, Randy Baker, David Anderson, Valerie Asardag, Aliye Nazli Bestwick, Jonathan Bramhall, Kath Dobson, Ruth Loveless, Samantha Schmierer, Klaus Upcott, Matthew Shah, Sita Navin George, Katila Hibbert, Aimee Moat, Stuart J. Robertson, Neil P. Tallantyre, Emma C. Jolles, Stephen Ingram, Gillian Jones, Meleri Willis, Mark Giovannoni, Gavin Vickaryous, Nicola Scurr, Martin J. Grant, Leanne Simmons, Jessica |
| AuthorAffiliation | 2 Department of Neurology University Hospital of Wales Cardiff UK 8 Department of Neurology Barts Health NHS Trust London UK 13 Wales Newborn Screening Laboratory, Department of Medical Biochemistry, Immunology and Toxicology University Hospital of Wales Cardiff UK 4 Blizard Institute, Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK 11 Department of Neurology Royal Gwent Hospital Newport UK 10 Department of Gastroenterology and Hepatology University Hospital of Wales Cardiff UK 14 School of Medicine Cardiff University Cardiff UK 6 Centre for Oral Immunobiology and Regenerative Medicine Barts and the London School of Medicine and Dentistry, Queen Mary University of London London UK 9 Division of Infection and Immunity School of Medicine, Cardiff University Cardiff UK 7 Department of Clinical Neurology University of Nottingham Nottingham UK 5 Immunodeficiency Centre for Wales University Hospital of Wales Cardiff UK 12 Department of Neurology Morriston |
| AuthorAffiliation_xml | – name: 6 Centre for Oral Immunobiology and Regenerative Medicine Barts and the London School of Medicine and Dentistry, Queen Mary University of London London UK – name: 1 Division of Psychological Medicine and Clinical Neuroscience School of Medicine, Cardiff University Cardiff UK – name: 10 Department of Gastroenterology and Hepatology University Hospital of Wales Cardiff UK – name: 11 Department of Neurology Royal Gwent Hospital Newport UK – name: 3 Preventive Neurology Unit Wolfson Institute of Population Health, Queen Mary University London London UK – name: 9 Division of Infection and Immunity School of Medicine, Cardiff University Cardiff UK – name: 4 Blizard Institute, Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK – name: 5 Immunodeficiency Centre for Wales University Hospital of Wales Cardiff UK – name: 7 Department of Clinical Neurology University of Nottingham Nottingham UK – name: 12 Department of Neurology Morriston Hospital Swansea UK – name: 2 Department of Neurology University Hospital of Wales Cardiff UK – name: 13 Wales Newborn Screening Laboratory, Department of Medical Biochemistry, Immunology and Toxicology University Hospital of Wales Cardiff UK – name: 14 School of Medicine Cardiff University Cardiff UK – name: 8 Department of Neurology Barts Health NHS Trust London UK – name: 15 ImmunoServ Ltd. Cardiff UK |
| Author_xml | – sequence: 1 givenname: Emma C. orcidid: 0000-0002-3760-6634 surname: Tallantyre fullname: Tallantyre, Emma C. organization: University Hospital of Wales – sequence: 2 givenname: Nicola surname: Vickaryous fullname: Vickaryous, Nicola organization: Wolfson Institute of Population Health, Queen Mary University London – sequence: 3 givenname: Valerie surname: Anderson fullname: Anderson, Valerie organization: School of Medicine, Cardiff University – sequence: 4 givenname: Aliye Nazli surname: Asardag fullname: Asardag, Aliye Nazli organization: Queen Mary University of London – sequence: 5 givenname: David orcidid: 0000-0002-8872-8711 surname: Baker fullname: Baker, David organization: Queen Mary University of London – sequence: 6 givenname: Jonathan surname: Bestwick fullname: Bestwick, Jonathan organization: Wolfson Institute of Population Health, Queen Mary University London – sequence: 7 givenname: Kath surname: Bramhall fullname: Bramhall, Kath organization: University Hospital of Wales – sequence: 8 givenname: Randy surname: Chance fullname: Chance, Randy organization: Barts and the London School of Medicine and Dentistry, Queen Mary University of London – sequence: 9 givenname: Nikos surname: Evangelou fullname: Evangelou, Nikos organization: University of Nottingham – sequence: 10 givenname: Katila surname: George fullname: George, Katila organization: Wolfson Institute of Population Health, Queen Mary University London – sequence: 11 givenname: Gavin surname: Giovannoni fullname: Giovannoni, Gavin organization: Barts Health NHS Trust – sequence: 12 givenname: Andrew surname: Godkin fullname: Godkin, Andrew organization: University Hospital of Wales – sequence: 13 givenname: Leanne surname: Grant fullname: Grant, Leanne organization: University Hospital of Wales – sequence: 14 givenname: Katharine E. surname: Harding fullname: Harding, Katharine E. organization: Royal Gwent Hospital – sequence: 15 givenname: Aimee surname: Hibbert fullname: Hibbert, Aimee organization: University of Nottingham – sequence: 16 givenname: Gillian surname: Ingram fullname: Ingram, Gillian organization: Morriston Hospital – sequence: 17 givenname: Meleri surname: Jones fullname: Jones, Meleri organization: Queen Mary University of London – sequence: 18 givenname: Angray S. surname: Kang fullname: Kang, Angray S. organization: Barts and the London School of Medicine and Dentistry, Queen Mary University of London – sequence: 19 givenname: Samantha surname: Loveless fullname: Loveless, Samantha organization: School of Medicine, Cardiff University – sequence: 20 givenname: Stuart J. surname: Moat fullname: Moat, Stuart J. organization: Cardiff University – sequence: 21 givenname: Neil P. surname: Robertson fullname: Robertson, Neil P. organization: University Hospital of Wales – sequence: 22 givenname: Klaus orcidid: 0000-0002-9293-8893 surname: Schmierer fullname: Schmierer, Klaus organization: Barts Health NHS Trust – sequence: 23 givenname: Martin J. surname: Scurr fullname: Scurr, Martin J. organization: ImmunoServ Ltd – sequence: 24 givenname: Sita Navin surname: Shah fullname: Shah, Sita Navin organization: Wolfson Institute of Population Health, Queen Mary University London – sequence: 25 givenname: Jessica surname: Simmons fullname: Simmons, Jessica organization: School of Medicine, Cardiff University – sequence: 26 givenname: Matthew surname: Upcott fullname: Upcott, Matthew organization: School of Medicine, Cardiff University – sequence: 27 givenname: Mark surname: Willis fullname: Willis, Mark organization: University Hospital of Wales – sequence: 28 givenname: Stephen surname: Jolles fullname: Jolles, Stephen email: jollessr@cardiff.ac.uk organization: School of Medicine, Cardiff University – sequence: 29 givenname: Ruth orcidid: 0000-0002-2993-585X surname: Dobson fullname: Dobson, Ruth email: ruth.dobson@qmul.ac.uk organization: Barts Health NHS Trust |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34687063$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adult Antibodies, Viral - blood Antibodies, Viral - drug effects Antirheumatic Agents - therapeutic use Blood CD20 antigen Cell number Confidence intervals Coronaviruses COVID-19 COVID-19 - prevention & control COVID-19 vaccines COVID-19 Vaccines - immunology Female Health risks Health services Humans Immune response Immune system Immunocompromised Host Immunosuppressive agents Lymphocytes Lymphocytes T Male Medical records Middle Aged Monoclonal antibodies Multiple sclerosis Multiple Sclerosis - drug therapy Multiple Sclerosis - immunology Respiratory diseases SARS-CoV-2 Seroconversion Seroconversion - drug effects Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Statistical analysis Therapy United Kingdom Vaccines Viral diseases |
| Title | COVID‐19 Vaccine Response in People with Multiple Sclerosis |
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