Effects of MS disease-modifying therapies on responses to vaccinations: A review.

Abstract

Background : Development of long-term immunologic memory relies upon humoral and cellular immune responses. Vaccinations aim to stimulate these responses against pathogens. Several studies have evaluated the impact of multiple sclerosis disease-modifying therapies on immune response to vaccines. Findings from these studies have important implications for people with multiple sclerosis who require vaccination and are using disease-modifying therapies. Methods : Searches using PubMed and other engines were conducted in May 2020 to collect studies evaluating the impact of various disease-modifying therapies on immune responses to vaccination. Results : Several studies demonstrated preserved immune responses in people treated with beta-interferons to multiple vaccine types. Limited data suggest vaccine responses to be preserved with dimethyl fumarate treatment, as well. Vaccine responses were reduced to varying degrees in those treated with glatiramer acetate, teriflunomide, sphingosine-1-phosphate receptor modulators, and natalizumab. The timing of vaccination played an important role in those treated with alemtuzumab. Humoral vaccine responses were significantly impaired by B cell depleting anti-CD20 monoclonal antibody therapies, particularly to a neoantigen. Data are lacking on vaccine responses in patients with multiple sclerosis taking cladribine and high-dose corticosteroids. Notably, the majority of these studies have focused on humoral responses, with few examining cellular immune responses to vaccination. Conclusions : Prior investigations into the effects of individual disease-modifying therapies on immune responses to existing vaccines can serve as a guide to expected responses to a SARS-CoV-2 vaccine. Responses to any vaccination depend on the vaccine type, the type of response (recall versus response to a novel antigen), and the impact of the individual disease-modifying therapy on humoral and cellular immunity in response to that vaccine type. When considering a given therapy, clinicians should weigh its efficacy against MS for the individual patient versus potential impact on responses to vaccinations that may be needed in the future.

COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review

“…However, a reduced immune response was reported after GA (not statistically significant in some studies), Teriflunomide, Fingolimod, Siponimod, Natalizumab, and anti-CD20 monoclonal antibody treatments. ( Ciotti et al, 2020 ) A recent study by Bar-Or A et al ( Bar-Or et al, 2020 ) provides Class II evidence confirming that the humoral response to non-live vaccines in RRMS patients after Ocrelizumab treatment was attenuated compared with untreated or Interferon-beta treated patients; however, they can still be expected to be protective. ( Bar-Or et al, 2020 )…”

“…The safety and efficacy of approvedvaccines for SARS-CoV-2 in MS patients on treatment with DMTs should be carefully considered. ( Ciotti et al, 2020 , Baker et al, 2020 )…”

“…In a review article, Ciotti JR et al ( Ciotti et al, 2020 ) evaluated the immune response to existing vaccines in patients on different DMTs to infer potential results of a vaccine against SARS-CoV-2. They showed that there were adequate immune responses in patients on Interferon-beta.…”

B cell targeting therapies in MS patients during the SARS-CoV-2 pandemic — when immunosuppression meets infection?

“…Given the key role of B cells in antibody development, any therapy affecting B cell status and function is expected to affect the humoural responses to a SARS-CoV-2 vaccine. Further studies are warranted to elucidate which B cell factors will be critical for the success of future vaccines against novel coronavirus [65].…”

“…Hopefully, the emergence of an effective vaccine for novel coronavirus will facilitate eradication of this pathogen. Current DMTs in MS are unlikely to inhibit development of the effective resistance via vaccination, although anti-B cell therapies may reduce its effectiveness [65,75]. Novel drugs in MS, including new approaches to tackle B cell function, should be designed to provide more selective and less immunosuppressive compound.…”