Immunogenicity of The Influenza Vaccine in Multiple Sclerosis Patients: A Systematic Review and Meta-Analysis

Nguyen, Jackie; Hardigan, Patrick C.; Kesselman, Marc M; Beckler, Michelle Demory

doi:10.1016/j.msard.2020.102698

Cited by 13 publications

(17 citation statements)

References 23 publications

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“…Thus, humoral immunity against SARS-CoV2 seems to be stable in MS with no indication of earlier loss than in the general population and comparable to response to other viral infections. 24,25 Reassuringly, we did not find a signal towards accelerated loss of seropositivity in patients treated with DMT overall or immunosuppressive DMT. Still, large-scale longitudinal studies with serial antibody testing will be needed to answer this question sufficiently.…”

Section: Discussionmentioning

confidence: 53%

Humoral immune response after COVID-19 in multiple sclerosis: A nation-wide Austrian study

et al. 2021

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Background: Knowledge on immunity after SARS-CoV-2 infection in patients with multiple sclerosis (pwMS) and the impact of disease-modifying treatment (DMT) is limited. Objective: To evaluate degree, duration and potential predictors of specific humoral immune response in pwMS with prior COVID-19. Methods: Anti-SARS-CoV-2 antibody testing was performed in pwMS with PCR-confirmed diagnosis of symptomatic COVID-19 from a nation-wide registry. Predictors of seropositivity were identified by multivariate regression models. Results: In 125 pwMS (mean age = 42.4 years (SD = 12.3 years), 70% female), anti-SARS-CoV-2 antibodies were detected in 76.0% after a median of 5.2 months from positive PCR. Seropositivity rate was significantly lower in patients on IS-DMT (61.4%, p = 0.001) than without DMT or immunomodulatory DMT (80.6%; 86.0%, respectively). In multivariate analysis, IS-DMT was associated with reduced probability of seropositivity (odds ratio (OR): 0.51; 95% confidence interval (95% CI): 0.17–0.82; p < 0.001). Predefined subgroup analyses showed marked reduction of seropositivity in pwMS on rituximab/ocrelizumab (OR 0.15; 95% CI: 0.05–0.56; p < 0.001). Rate of seropositivity did not change significantly over 6 months. Conclusions: Humoral immunity is stable after SARS-CoV-2 infection in MS, but is reduced by immunosuppressive DMT, particularly anti-CD20 monoclonal antibodies. This provides important evidence for advising pwMS as well as for planning and prioritizing vaccination.

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Section: Discussionmentioning

confidence: 53%

Humoral immune response after COVID-19 in multiple sclerosis: A nation-wide Austrian study

et al. 2021

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“…However, increases in influenza-specific T cells following vaccination are higher in people with MS than in healthy controls and, importantly, no increases in T cell responses to central nervous system myelin proteins (i.e., human myelin basic protein or recombinant human myelin oligodendrocyte protein) were seen [ 83 ]. A meta-analysis of studies on influenza vaccination in patients with MS found no statistical difference in immune responses versus healthy controls and that most immunotherapies did not affect the immune response [ 84 ].…”

Section: Vaccine Efficacy and Dmtsmentioning

confidence: 99%

Vaccine Considerations for Multiple Sclerosis in the COVID-19 Era

et al. 2021

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People with multiple sclerosis (MS) are at risk for infections that can result in amplification of baseline symptoms and possibly trigger clinical relapses. Vaccination can prevent infection through the activation of humoral and cellular immune responses. This is particularly pertinent in the era of emerging novel vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). MS disease-modifying therapies (DMTs), which affect the immune system, may impact immune responses to COVID-19 vaccines in people with MS. The objective of this article is to provide information on immune system responses to vaccinations and review previous studies of vaccine responses in people with MS to support the safety and importance of receiving currently available and emerging COVID-19 vaccines. Immunological studies have shown that coordinated interactions between T and B lymphocytes of the adaptive immune system are key to successful generation of immunological memory and production of neutralizing antibodies following recognition of vaccine antigens by innate immune cells. CD4 + T cells are essential to facilitate CD8 + T cell and B cell activation, while B cells drive and sustain T cell memory. Data suggest that some classes of DMT, including type 1 interferons and glatiramer acetate, may not significantly impair the response to vaccination. DMTs—such as sphingosine-1-phosphate receptor modulators, which sequester lymphocytes from circulation; alemtuzumab; and anti-CD20 therapies, which rely on depleting populations of immune cells—have been shown to attenuate responses to conventional vaccines. Currently, three COVID-19 vaccines have been granted emergency use authorization in the USA on the basis of promising interim findings of ongoing trials. Because analyses of these vaccines in people with MS are not available, decisions regarding COVID-19 vaccination and DMT choice should be informed by data and expert consensus, and personalized with considerations for disease burden, risk of infection, and other factors.

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“… 2 Effects of immunosuppressive treatment on immunogenicity of vaccines might depend on the drug and vaccine type, and potentially the autoimmune disease type. 3 , 4 , 5 , 6 For example, results of a meta-analysis by Pugès and colleagues indicate that seroconversion rates after influenza vaccination, but not pneumococcal vaccination, are lower in patients with systemic lupus erythematosus than in healthy controls. 6 By contrast, others have found diminished seroconversion after pneumococcal vaccination in patients with rheumatoid arthritis treated with methotrexate compared with healthy controls or patients treated with TNF inhibitors, 7 , 8 whereas findings from studies reporting the effects of methotrexate on seroconversion rates after influenza vaccination have been inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Antibody development after COVID-19 vaccination in patients with autoimmune diseases in the Netherlands: a substudy of data from two prospective cohort studies

Boekel

Steenhuis

Hooijberg

et al. 2021

The Lancet Rheumatology

148

165

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Background Data are scarce on immunogenicity of COVID-19 vaccines in patients with autoimmune diseases, who are often treated with immunosuppressive drugs. We aimed to investigate the effect of different immunosuppressive drugs on antibody development after COVID-19 vaccination in patients with autoimmune diseases. Methods In this study, we used serum samples collected from patients with autoimmune diseases and healthy controls who were included in two ongoing prospective cohort studies in the Netherlands. Participants were eligible for inclusion in this substudy if they had been vaccinated with any COVID-19 vaccine via the Dutch national vaccine programme, which at the time was prioritising vaccination of older individuals. Samples were collected after the first or second COVID-19 vaccination. No serial samples were collected. Seroconversion rates and IgG antibody titres against the receptor-binding domain of the SARS-CoV-2 spike protein were measured. Logistic and linear regression analyses were used to investigate the association between medication use at the time of vaccination and at least until sampling, seroconversion rates, and IgG antibody titres. The studies from which data were collected are registered on the Netherlands Trial Register, Trial ID NL8513, and ClinicalTrials.org, NCT04498286. Findings Between April 26, 2020, and March 1, 2021, 3682 patients with rheumatic diseases, 546 patients with multiple sclerosis, and 1147 healthy controls were recruited to participate in the two prospective cohort studies. Samples were collected from patients with autoimmune diseases (n=632) and healthy controls (n=289) after their first (507 patients and 239 controls) or second (125 patients and 50 controls) COVID-19 vaccination. The mean age of both patients and controls was 63 years (SD 11), and 423 (67%) of 632 patients with autoimmune diseases and 195 (67%) of 289 controls were female. Among participants without previous SARS-CoV-2 infection, seroconversion after first vaccination were significantly lower in patients than in controls (210 [49%] of 432 patients vs 154 [73%] of 210 controls; adjusted odds ratio 0·33 [95% CI 0·23–0·48]; p<0·0001), mainly due to lower seroconversion in patients treated with methotrexate or anti-CD20 therapies. After the second vaccination, seroconversion exceeded 80% in all patient treatment subgroups, except among those treated with anti-CD20 therapies (three [43%] of seven patients). We observed no difference in seroconversion and IgG antibody titres between patients with a previous SARS-CoV-2 infection who had received a single vaccine dose (72 [96%] of 75 patients, median IgG titre 127 AU/mL [IQR 27–300]) and patients without a previous SARS-CoV-2 infection who had received two vaccine doses (97 [92%] of 106 patients, median IgG titre 49 AU/mL [17–134]). Interpretation Our data suggest that seroconversion after a first COVID-19 vaccination is delay...

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Immunogenicity of The Influenza Vaccine in Multiple Sclerosis Patients: A Systematic Review and Meta-Analysis

Cited by 13 publications

References 23 publications

Humoral immune response after COVID-19 in multiple sclerosis: A nation-wide Austrian study

Humoral immune response after COVID-19 in multiple sclerosis: A nation-wide Austrian study

Vaccine Considerations for Multiple Sclerosis in the COVID-19 Era

Antibody development after COVID-19 vaccination in patients with autoimmune diseases in the Netherlands: a substudy of data from two prospective cohort studies

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