COVID-19 infection after SARS-CoV-2 mRNA vaccination in Multiple Sclerosis, AQP4-antibody NMOSD and MOGAD patients during the Omicron subvariant BA.1/2 wave in Singapore

Abstract

Background The SARS-CoV-2 Omicron variant appears to cause milder infections, however, its capacity for immune evasion and high transmissibility despite vaccination remains a concern, particularly in immunosuppressed patients. Herein, we investigate the incidence and risk factors for COVID-19 infection in vaccinated adult patients with Multiple Sclerosis (MS), Aquaporin-4-antibody Neuromyelitis Optica Spectrum Disorder (AQP4-Ab NMOSD), and Myelin Oligodendrocyte Glycoprotein-antibody associated disease (MOGAD) during the Omicron subvariant BA.1/2 wave in Singapore. Methods This was a prospective observational study conducted at the National Neuroscience Institute, Singapore. Only patients who had at least two doses of mRNA vaccines were included. Data on demographics, disease characteristics, COVID-19 infections and vaccinations, and immunotherapies were collected. SARS-CoV-2 neutralising antibodies were measured at various time points after vaccination. Results Two hundred and one patients were included; 47 had COVID-19 infection during the study period. Multivariable logistic regression revealed that receipt of a third SARS-CoV-2 mRNA vaccination (V3) was protective against COVID-19 infection. No particular immunotherapy group increased the risk of infection, however, Cox proportional-hazards regression showed that patients on anti-CD20s and sphingosine-1-phosphate modulators (S1PRMs) had a shorter time to infection after V3, compared to those on other immunotherapies or not on immunotherapy. Conclusions The Omicron subvariant BA.1/2 is highly infectious in patients with central nervous system inflammatory diseases; three doses of mRNA vaccination improved protection. However, treatment with anti-CD20s and S1PRMs predisposed patients to earlier infection. Future studies are required to determine the protective efficacy of newer bivalent vaccines that target the Omicron (sub)variant, especially in immunocompromised patients.

Immunosuppressive therapy and COVID‐19 infection in patients with NMOSD

“…The prevalence of COVID‐19 in NMOSD patients was found to be 1.2% till July 2021 12 . A Singaporean study found COVID‐19 Omicron BA.1/2 wave infection in vaccinated patients with MS, NMOSD, and MOGAD was 23.4% over a 4‐month period 13 . 85.7% of NMOSD patients reported that had developed COVID‐19 clinical symptoms in our study.…”

“… 12 A Singaporean study found COVID‐19 Omicron BA.1/2 wave infection in vaccinated patients with MS, NMOSD, and MOGAD was 23.4% over a 4‐month period. 13 85.7% of NMOSD patients reported that had developed COVID‐19 clinical symptoms in our study. Despite the relatively high prevalence rate in our cohort, there is no difference between NMOSD group and HC group.…”

Influence of Disease Modifying Treatment, Severe Acute Respiratory Syndrome Coronavirus 2 Variants and Vaccination on Coronavirus Disease 2019 Risk and Outcome in Multiple Sclerosis and Neuromyelitis Optica

“…In particular, both antibody production and memory B cell responses were impaired when treated with anti-CD20 antibodies. Both humoral and T cell responses were also diminished in patients treated with S1P-r modulators [8,[18][19][20]. Accordingly, we found an approximately two-fold increased risk to contract SARS-CoV-2 infection in vaccinated MS patients who were treated with anti-CD20 at time of vaccination.…”