SARS-CoV-2 Serology Among People with Multiple Sclerosis on Disease-Modifying Therapies after BBIBP-CorV (Sinopharm) Inactivated Virus Vaccination: Same Story, Different Vaccine

Etemadifar, Masoud; Sedaghat, Nahad; Nouri, Hosein; Lotfi, Noushin; Chitsaz, Ahmad; Khorvash, Reza; Zolfaghari, Hamed; Pourabbas, Mohammad; Salari, Mehri

doi:10.2139/ssrn.3942531

Cited by 6 publications

(8 citation statements)

References 4 publications

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“…Additional studies have corroborated the finding that the humoral immune response to mRNA and ChAdOx1 nCoV-19 vaccines is reduced in patients with MS receiving treatment with either a selective S1P1 receptor modulator or CD20 antibody therapy 154 , 199 – 203 , and similar results have been obtained with an inactivated SARS-CoV-2 vaccination (BBIBP-CorV) 204 , 205 . However, the overall antibody response to the ChAdOx1 nCoV-19 vaccine seems to be lower than that to the BNT162b2 vaccine 200 .…”

Section: Sars-cov-2 In Neuroimmunological Diseasessupporting

confidence: 57%

Vaccination and immunotherapies in neuroimmunological diseases

et al. 2022

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Section: Sars-cov-2 In Neuroimmunological Diseasessupporting

confidence: 57%

Vaccination and immunotherapies in neuroimmunological diseases

et al. 2022

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“…Moderate-certainty evidence did not suggest decreased odds of post-vaccination seroconversion in the pwMS on GA compared to the UX people (OR [95%CI]: 0.87 [0.31, 2.42], P=0.79) (Supplementary Figure 2). Post-vaccination seronegative pwMS on GA were only present in two studies 21,22 – all being among the ones receiving inactivated vaccination. Quantitative analysis in suggested no difference in post-vaccination antibody concentrations between GA-treated pwMS and the UX people in any study.…”

Section: Resultsmentioning

confidence: 93%

“…All included studies 16,17,[19][20][21][22][25][26][27][28][29][30][31] , headto-head mRNA-AV 29 and mRNA-inactivated 22 immunogenicity comparisons in S1PRM-treated pwMS have suggested the opposite. Hence, the need for more replication of inactivated/mRNA/AV comparisons is clearly sensed for pwMS on S1PRM.…”

Section: Sphingosine-1-phosphate Receptor Modulators (S1prm)mentioning

confidence: 99%

Multiple sclerosis disease-modifying therapies and COVID-19 vaccines: A practical review and meta-analysis

Etemadifar

Nouri

Pitzalis

et al. 2022

Preprint

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Importance: An evidence-based appraisal of the COVID-19 vaccination policies among people with multiple sclerosis (pwMS) with respect to disease-modifying therapies (DMT) is important for our understandings and their further management. Objective: To synthesize the available evidence concerning the effect of DMTs on COVID-19 vaccination immunogenicity and effectiveness. Data Sources: We searched MEDLINE, Scopus, Web of Science, MedRxiv, and Google Scholar from January 2021 until January 2022. Study Selection: The exclusion criteria included: not a primary investigation; retracted/withdrawn; no eligible participants - people with no history/evidence of previous COVID-19 and corticosteroid administration within two months of vaccination; no eligible exposures - all nine DMT classes; and no eligible comparators - DMT-unexposed at the time of vaccination. Data Extraction and Synthesis: Entries were assessed independently by two reviewers for eligibility and quality. Dichotomized data was extracted by two reviewers in accordance with Cochrane guidelines, and were pooled using either Peto fixed-effects or Inverse-variance random-effects methods. Main Outcomes and Measures: Main outcomes were i) B-cell response, measured by seroconversion odds ratio (OR); ii) T-cell response, measured by interferon-gamma release response OR, and CD4+/CD8+ activation-induced marker+ OR. Further outcomes including immunity waning speed and breakthrough COVID-19 incidence/severity were synthesized narratively. Results: Data from 28 studies (5,025 pwMS and 1,635 healthy participants) after COVID-19 vaccination suggests mildly-lower B-cell responses in teriflunomide- and alemtuzumab-treated, extensively-lower B-cell responses in sphingosine-1-phosphate receptor modulator (S1PRM)- and anti-CD20 (aCD20)-treated, and lower T-cell responses in interferon-, S1PRM-, alemtuzumab- and cladribine-treated pwMS. Every ten-week increase in aCD20-to-vaccine period is associated with a 1.94-time (95%CI: 1.57, 2.41, P<0.00001) increase in odds of seroconversion. B-cell-depleting therapies seem to accelerate post-vaccination humoral waning, and booster immunogenicity is predictable with the same factors affecting the priming vaccination. Furthermore, comparatively-increased breakthrough COVID-19 incidence and severity is being observed only among S1PRM- and anti-CD20-treated pwMS - i.e., among the pwMS with extensively-blunted B-cell response, despite adequate T-cell responses in the aCD20-treated. To date, pwMS on only-T-cell-blunting DMTs have not shown increased susceptibility to breakthrough COVID-19. Conclusion and Relevance: The implemented vaccination strategy to date has been effective for pwMS on all DMTs other than S1PRM and aCD20. As B-cell immunity seems to be a more important predictor of vaccine effectiveness than T-cell immunity, optimization of humoral immunogenicity and ensuring its durability among pwMS on DMTs are the necessities of an effective COVID-19 vaccination policy.

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“…41 The mRNA vaccines were more likely to produce an antibody response in controls and pwMS as compared to other vaccines, especially the inactivated viral vaccine. The majority of patients with measured responses to the inactivated viral vaccine were from a single study 14 that also used a different antibody detection assay than the other studies, so the differences observed could be either the vaccine itself or the assay performed. However, the assay has been validated, so the differences are most likely due to the vaccine type.…”

Section: Vaccine-mediated Immunitymentioning

confidence: 99%

Immune responses to SARS‐CoV‐2 vaccination in multiple sclerosis: a systematic review/meta‐analysis

Gombolay

Dutt

Tyor

2022

Ann Clin Transl Neurol

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Introduction Responses to SARS‐CoV‐2 vaccination in patients with MS (pwMS) varies by disease‐modifying therapies (DMTs). We perform a meta‐analysis and systematic review of immune response to SARS‐CoV‐2 vaccines in pwMS. Methods Two independent reviewers searched PubMed, Google Scholar, and Embase from January 1, 2019‐December 31, 2021, excluding prior SARS‐CoV‐2 infections. The meta‐analysis of observational studies in epidemiology (MOOSE) guidelines were applied. The data were pooled using a fixed‐effects model. Results Eight‐hundred sixty‐four healthy controls and 2203 pwMS from 31 studies were included. Antibodies were detected in 93% healthy controls (HCs), and 77% pwMS, with >93% responses in all DMTs (interferon‐beta, glatiramer acetate, cladribine, natalizumab, dimethyl fumarate, alemtuzumab, and teriflunomide) except for 72% sphingosine‐1‐phosphate modulators (S1PM) and 44% anti‐CD20 monoclonal antibodies (mAbs). T‐cell responses were detected in most anti‐CD20 and decreased in S1PM. Higher antibody response was observed in mRNA vaccines (99.7% HCs) versus non‐mRNA vaccines (HCs: 72% inactivated virus; pwMS: 86% vector, 59% inactivated virus). A multivariate logistic regression model to predict vaccine response demonstrated that mRNA versus non‐mRNA vaccines had a 3.4 odds ratio (OR) for developing immunity in anti‐CD20 (p = 0.0052) and 7.9 OR in pwMS on S1PM or CD20 mAbs (p < 0.0001). Antibody testing timing did not affect antibody detection. Conclusion Antibody responses are decreased in S1PM and anti‐CD20; however, cellular responses were positive in most anti‐CD20 with decreased T cell responses in S1PM. mRNA vaccines had increased seroconversion rates compared to non‐RNA vaccines. Further investigation in how DMTs affect vaccine immunity are needed.

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SARS-CoV-2 Serology Among People with Multiple Sclerosis on Disease-Modifying Therapies after BBIBP-CorV (Sinopharm) Inactivated Virus Vaccination: Same Story, Different Vaccine

Cited by 6 publications

References 4 publications

Vaccination and immunotherapies in neuroimmunological diseases

Vaccination and immunotherapies in neuroimmunological diseases

Multiple sclerosis disease-modifying therapies and COVID-19 vaccines: A practical review and meta-analysis

Immune responses to SARS‐CoV‐2 vaccination in multiple sclerosis: a systematic review/meta‐analysis

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