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Numerous efforts are ongoing to characterize the biological response to SARS-CoV-2 vaccination around the world. Two research groups now report findings on vaccination response in patients with multiple sclerosis (MS) taking various disease-modifying therapies.
Brill and colleagues studied SARS-CoV-2 serologies and T-cell responses in 72 patients with MS who received the BNT162b2 vaccine, 49 of whom were treated with ocrelizumab. Of 29 ocrelizumab recipients tested, 89.7% developed SARS-CoV-2–specific T cells after vaccination, at a level similar to controls. However, SARS-CoV-2 antibody testing was positive after vaccination in only 49.2% of those on ocrelizumab.
Disanto and colleagues performed a prospective observational cohort study on 116 patients with MS who received SARS-CoV-2 mRNA vaccines. Of the 120 participants, 58 were on anti-CD20 therapy, 9 on sphingosine-1-phosphatase receptor (S1P) modulator therapy, 15 on cladribine, 24 on teriflunomide, and 14 received no therapy. Postvaccine seropositive response was observed for 51.8% of those on an anti-CD20 and 66.7% on S1P modulators, versus 92.9% on cladribine and all those on teriflunomide or no therapy.
Brill L et al. Humoral and T-cell response to SARS-CoV-2 vaccination in patients with multiple sclerosis treated with ocrelizumab. JAMA Neurol 2021 Sep 23; [e-pub]. (https://doi.org/10.1001/jamaneurol.2021.3599)
Disanto G et al. Association of disease-modifying treatment and anti-CD20 infusion timing with humoral response to 2 SARS-CoV-2 vaccines in patients with multiple sclerosis. JAMA Neurol 2021 Sep 23; [e-pub]. (https://doi.org/10.1001/jamaneurol.2021.3609)
Comment
Many scientific questions remain concerning the differences among MS disease-modifying therapies and risk for COVID-19 after natural SARS-CoV-2 infection or vaccination. These findings are consistent with other reports that SARS-CoV-2 serologic responses are reduced in patients taking an anti-CD20 drug or S1P modulator. However, the precise role of serology levels in preventing future infection remains undefined. Furthermore, T-cell immunity remains preserved with anti-CD20 therapies, which may contribute to preventing or reducing the severity of COVID-19. Vaccination is recommended prior to treatment with either of these agents, with a risk-benefit analysis for patients with highly active MS who may not be able to wait to begin treatment. For patients with MS, including those on any of these therapies, COVID-19 vaccination remains strongly recommended. Full and updated vaccine recommendations can be found on the National MS Society website.