New study finds reduced antibodies from COVID vaccines in MS patients on certain DMTs

19 Nov 2021

A study published in the Annals of Neurology last month found that people with multiple sclerosis (MS) on certain disease-modifying therapies (DMTs) produced less antibodies in response to the SARS-CoV-2 - or COVID-19 - vaccination in comparison to the general populace.

Corresponding author Ruth Dobson, along with a large group of colleagues from the Barts MS team, conducted the research to investigate the effect of DMTs on immune response to COVID-19 vaccines in people with MS.

The team took dried blood spot samples from 473 people with MS and used information about COVID-19 and vaccine history, medical, and drug history were extracted from questionnaires and medical records. They found that those people with MS treated with anti-CD20 medications, and those treated with fingolimod, both had lower antibody responses to the vaccine.

Key comments from amongst the paper's 'discussion' summarise some of the findings well:

'This study answers some of the questions that have arisen around vaccine efficacy in people with MS taking immunomodulatory drugs. With a cohort of almost 500 patients, we have demonstrated that both DMT type and vaccine type affect humoral immune response to the COVID-19 vaccination, offering an opportunity to provide advice about infection-prevention and control for people at risk. However, certain DMTs, including some with high MS treatment efficacy, appear to have no effect on the response to the COVID-19 vaccination.'

'Anti-CD20 monoclonal antibodies were the DMTs most strongly associated with lack of seroconversion following the COVID-19 vaccination.'

'We also found that fingolimod, a sphingosine-1-phospohate (S1P) receptor modulator, is associated with both a substantially attenuated humoral response to the COVID-19 vaccination and a low number of T cell responders in the vaccine nonresponders.'

The paper discusses some of the opportunities for further research, and implications for practice, such as:

'Our data offers the opportunity to tailor advice for people with MS who are at risk of attenuated humoral response to vaccination. Our study suggested that delaying commencement of fingolimod or anti-CD20 DMT should be considered in new starters, to allow time for vaccination.'

They also offer some assurances to those with MS who are currently being treated with a DMT impacting vaccine response - particularly those on anti-CD20 medication ocrelizumab:

'The intact T cell response in 4 of 6 vaccine nonresponders on ocrelizumab provides some potential reassurance to those who have received the vaccine close to their infusion time.'

Find the open access study online.

Ref: Tallantyre EC, Vickaryous N, Anderson V, Asardag AN, Baker D, Bestwick J, Bramhall K, Chance R, et al; 'COVID-19 Vaccine Response in People with Multiple Sclerosis', Annals of Neurology, First published: 22 October 2021

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