Patients with multiple sclerosis (MS) treated with interferon beta-1a (IFN) demonstrated significantly increased humoral responses to the Pfizer mRNA vaccine for COVID-19, according to new study results published in Multiple Sclerosis and Related Disorders.

In contrast, patients with MS taking cladribine (CLAD), fingolimod (FTY), and ocrelizumab (OCRE) showed a weakened humoral response. Patients on CLAD, FTY, OCRE, teriflunomide (TERI), and natalizumab (NAT) all exhibited impaired intrinsic antispike specific antibody productions, while patients on glatiramer acetate (GA) and dimethyl fumarate (DMF) showed preserved antibody productions.

The concern regarding mRNA COVID-19 vaccine efficacy in patients who are immunocompromised is what prompted researchers to assess immunogenicity. They assessed individuals with MS following vaccination who are at higher risks for serious COVID-19 complications.


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“DMTs [disease-modifying therapies] could have a key role in the protection from [COVID-19] and complication in MS subjects, underlying a novel aspect that should be considered in the selection of the most appropriate therapy,” the authors said. Investigators enrolled 125 patients with MS and 24 healthy control participants into their prospective study from March to June 2021 at the Cardarelli Hospital Multiple Sclerosis Center in Naples, Italy.

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Requirements for participation included no prior history of COVID-19 infection, aged between 18 and 65 years, and an MS diagnosis with at least 6 months of DMT treatment. In the MS cohort, 93.6% (117 of 125) had relapsing-remitting MS, 3.2% (4 of 125) had primary progressive MS, and 3.2% (4 of 125) had secondary progressive MS.

Patients with MS receiving IFN (n=22), GA (n=9), TERI (n=10), DMF (n=18), FTY (n=19), and NAT (n=22) received COVID-19 vaccinations without interruption of immunomodulatory treatments. Those receiving CLAD (n=10) and OCRE (n=15) received vaccinations at least 1 or 3 months, respectively, following their last DMT administration.

Researchers collected blood samples at baseline, first vaccination, and second vaccination to assess both spike protein antibody measurement within 4 hours and then completed immunophenotypic analysis within 24 hours of collection. Patients treated with IFN showed significantly increased antispike immunoglobulin G (IgG) antibody levels compared with healthy individuals, and patients undergoing treatment with CLAD, FTY, and OCRE exhibited significantly reduced IgG levels.

Compared with patients treated with IFN, the augmented antibody production in those receiving DMF was statistically insignificant. Between the first and second vaccines, investigators observed reduced antibody production in patients taking TERI, NAT, CLAD, FTY, and OCRE.

Following the second vaccine, investigators observed direct correlations between antispike IgG levels and baseline B cell count in patients on INF (r =.22, P =.03) and DMF (r =.44, P =.03), and between antispike IgG levels and baseline T cell count in patients on GA (r =.48, P = .04).

“These findings underline that the impact of DMTs on B and T cell count could affect the humoral response to [COVID-19] vaccine in MS subjects,” the authors concluded.

Reference

Maniscalco GT, Manzo V, Ferrara AL, et al. Interferon beta-1a treatment promotes SARS-CoV-2 mRNA vaccine response in multiple sclerosis subjects. Mult Scler Relat Disord. 2022;58:103455. doi:10.1016/j.msard.2021.103455