Summary of Safety and Efficacy of COVID Vaccination in Patients with Multiple Sclerosis

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents one of the most challenging issues that have recently influenced everyday life in countries all over the world. Understanding the risk of this disease is of high importance in patients with multiple sclerosis (MS) as they represent a vulnerable population through their treatment with disease-modifying therapies (DMTs). Infective episodes may trigger relapses and lead to deterioration of the health condition. Summary: Vaccination is an important preventive measure against infectious diseases. In MS patients concerns have been raised about the effectiveness of vaccines in patients on various immunomodulatory drugs and about their possible adverse effects including impairment of neurological functions. The objective of this article is to summarize the current knowledge on immune responses to the COVID-19 vaccines and their safety in MS patients and to provide practical guidance based on the data available to date. Key Messages: Although MS is not associated with a higher risk of COVID-19, this infection can trigger relapses or pseudo-relapses. Vaccines against SARS-CoV-2 are recommended for all MS patients who are not in the active phase of the disease, despite the fact that there is still a lack of long-term reliable data on the effectiveness and safety of vaccines against COVID-19. Some DMTs can reduce vaccine humoral responses, but might still provide some protection and adequate T cell response. To optimize the effectiveness of vaccination, the ideal timing of vaccine application and DMTs dosing regimen is crucial.

B-cell-depleted patients with persistent SARS-CoV-2 infection: combination therapy or monotherapy? A real-world experience

“…IC individuals have been under-represented in previous registration of randomized clinical trials but are likely to be overrepresented among currently hospitalized patients with severe or persisting symptoms due to SARS-CoV-2, as they have impaired responses to vaccination and/or previous natural infection (19)(20)(21).…”

The Prevalence of Multiple Sclerosis Relapse following COVID-19 infection vs COVID-19 Vaccine

“…Without their participation, the vaccines' effectiveness for MS population will remain uncertain, leaving them vulnerable to the virus's severe effects (25). Although, MS patients are anxious about how their condition or their therapies might impact the safety of the COVID-19 vaccines, patients on DMTs are not at a higher risk of experiencing COVID-with severe symptoms (26). Multiple sclerosis (MS) patients treated with fingolimod and ocrelizumab may have a reduced immune response, making it important to monitor their SARS-CoV-2 antibody titer after vaccination.…”

“…individual circumstances (risk factors, age, MS disease progression and phase, prognosis, and lymphocyte count) should be considered when it comes to optimizing vaccine efficacy. More specific investigations may be issued to recognize the effect of DMT regimen type on post-vaccination MS relapse rate (26). Formal registries of the type of DMT administered and adjusting the study sample of vaccinated MS patients for their DMT Regimen in the analysis (which unfortunately hasn`t been done in the analyzed studies) and concomitant usage of DMTs that attenuate the autoimmune reactions after vaccination seem to be several helpful steps in protection against vaccine-associated relapses of MS.…”