Risk of COVID-19 in people with multiple sclerosis who are seronegative following vaccination

Abstract

Background: People with multiple sclerosis (pwMS) treated with certain disease-modifying therapies (DMTs) have attenuated IgG response following COVID-19 vaccination; however, the clinical consequences remain unclear. Objective: To report COVID-19 rates in pwMS according to vaccine serology. Methods: PwMS with available (1) serology 2–12 weeks following COVID-19 vaccine 2 and/or vaccine 3 and (2) clinical data on COVID-19 infection/hospitalisation were included. Logistic regression was performed to examine whether seroconversion following vaccination predicted risk of subsequent COVID-19 infection after adjusting for potential confounders. Rates of severe COVID-19 (requiring hospitalisation) were also calculated. Results: A total of 647 pwMS were included (mean age 48 years, 500 (77%) female, median Expanded Disability Status Scale (EDSS) 3.5% and 524 (81%) exposed to DMT at the time of vaccine 1). Overall, 472 out of 588 (73%) were seropositive after vaccines 1 and 2 and 222 out of 305 (73%) after vaccine 3. Seronegative status after vaccine 2 was associated with significantly higher odds of subsequent COVID-19 infection (odds ratio (OR): 2.35, 95% confidence interval (CI): 1.34–4.12, p = 0.0029), whereas seronegative status after vaccine 3 was not (OR: 1.05, 95% CI: 0.57–1.91). Five people (0.8%) experienced severe COVID-19, all of whom were seronegative after most recent vaccination. Conclusion: Attenuated humoral response to initial COVID-19 vaccination predicts increased risk of COVID-19 in pwMS, but overall low rates of severe COVID-19 were seen.

Long-Term Observation of SARS-CoV-2 Vaccination Response upon High Efficacy Treatment in Multiple Sclerosis—A Real-World Scenario

“…The minor increase in the number of pwMS who seroconvert under anti-CD20, and the greater proportion of those who do the same under ns-S1P, mirrors the vaccination response. Previous work is contradictory as to whether this correlates with a mitigated or sustained risk of infection [ 16 , 17 ]. Hospitalisation was not reported to be different between treatment groups after immunisation, and most importantly, none of the patients in our cohort had to undergo hospital care [ 17 ].…”

“…Previous studies have confirmed a greater risk of a breakthrough infection with lower anti-SARS-CoV-2-specific antibody levels and under certain disease-modifying therapies (DMTs) [ 13 , 14 , 15 , 16 ]. Especially under anti-CD20, the COVID-19 disease course was shown to remain more severe even after initial immunisation [ 15 , 17 ].…”

Longitudinal study of immunity toSARS‐CoV2in ocrelizumab‐treatedMSpatients up to 2 years afterCOVID‐19 vaccination

“… 1 , 2 However, immunocompromised individuals who have only a partial immune response to exogenous antigens are not fully immunoprotected after the relevant antigenic exposures. 3 Thus, multiple sclerosis (MS) patients whose humoral immunity has been depressed with therapeutic B‐cell depletion have a higher incidence of COVID‐19 infections 4 , 5 , 6 , 7 and COVID‐19‐related hospitalizations 8 after they have been vaccinated compared to non‐B‐cell‐depleted, vaccinated MS patients. 9 At the same time, B‐cell‐depleted patients do benefit from vaccinations, as evidenced by their many‐fold lower COVID‐19 hospitalization rates following vaccination relative to the pre‐vaccination epoch.…”