A new observational study found that multiple sclerosis (MS) patients treated with fingolimod or anti-CD20 monoclonal antibodies (mAbs) developed limited humoral response after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, when compared with untreated patients or those who received other treatments.
“Consequently, these patients could be at risk of recurrent infection and could benefit from anti–SARS-CoV-2 vaccination,” suggested the authors of the study published in Neurology Neuroimmunology & Neuroinflammation.
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Bigaut et al evaluated the humoral response after SARS-CoV-2 infection of patients followed at MS centers in Alsace, France, who had available serology (IgG index >6 weeks from COVID-19 onset). The investigation included 61 patients with MS (age, 46.2 ± 15.6 years, 67.2% female) grouped by the following disease-modifying treatments (DMTs):
- No treatment, n=14
- No risk treatment, n=8 (included interferon β-1a, n=3, and glatiramer acetate [Copaxone®], n=5),
- Low risk treatment, n=24 (included teriflunomide [Aubagio®], n=8, dimethyl fumarate [Tecfidera®], n=7, natalizumab [Tysabri®], n=6, and mycophenolate, n=3)
- Moderate to high risk treatment, n=15 (included fingolimod [Gilenya®], n=9, rituximab [Rituxan® or Mabthera], n=1, and ocrelizumab [Ocrevus®], n=5).
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Patients in the moderate to high risk DMT group showed a negative serologic status more frequently (8/15 patients: 4/6 patients with anti-CD20 mAb treatment and 4/9 patients with fingolimod treatment) than the group with no treatment (3/16 patients, P =.04) and the low-risk group (5/25 patients, P =.05).
These findings are in agreement with other studies. However, this study only looked into the humoral response, thereby not considering cellular immunity.
Rituximab and ocrelizumab are both mAbs designed to target CD20-positive B cells, but rituximab is used off-label to treat MS. Fingolimod inhibits the sphingosine-1-phosphate (S1P) receptor on T lymphocytes.
Bigaut K, Kremer L, Fabacher T, et al. Impact of disease-modifying treatments of multiple sclerosis on anti–SARS-CoV-2 antibodies. Neurol Neuroimmunol Neuroinflamm. 2021;8(5):e1055. doi:10.1212/NXI.0000000000001055