Tetravalent Influenza Vaccine Is Not Associated With Neuroaxonal Damage in Multiple Sclerosis Patients

Abstract

BackgroundEfficacy of vaccines and disease activity linked to immunization are major concerns among people with multiple sclerosis (pwMS).ObjectiveTo assess antibody responses to seasonal influenza antigens and vaccine-associated neuroaxonal damage utilizing serum neurofilament light chain (sNfL) in pwMS receiving dimethyl fumarate (DMF).MethodsIn this prospective study, the 2020/2021 seasonal tetravalent influenza vaccine was administered to 20 pwMS treated with DMF and 15 healthy controls (HCs). The primary endpoints were responder rate of strain-specific antibody production (seroconversion or significant (4-fold) increase in influenza-antibody titers for ≥2/4 strains) at 30 days post-vaccination and changes in sNfL levels.ResultsAll patients treated with DMF fulfilled the responder criteria for immunization compared with 53% of the controls. However, higher proportions of HCs already had influenza-antibody titers ≥1:40 at baseline (53% vs. 41%, p = 0.174). sNfL levels were comparable among both groups at baseline and did not increase 34 days after vaccination. In addition, no clinical or radiological disease reactivation was found.ConclusionDMF-treated patients mount an adequate humoral immune response to influenza vaccines. Within the limits of the small cohort investigated, our data suggest that influenza immunization is not associated with clinical or subclinical disease reactivation.

Vaccine response in people with multiple sclerosis treated with fumarates

“…58 As described earlier, sNfL levels, when assessed as a marker for disease activity in 20 pwMS on DMF who received the seasonal influenza vaccine, did not change significantly in the 4 weeks post-vaccination compared with baseline, and showed no significant difference from levels observed in healthy controls. 42 In addition, in the 4 weeks following vaccination, there were no relapses, neurological deteriorations, or gadolinium-enhancing lesions, while 80% (n = 16 out of 20) of patients showed no new/newly enlarging lesions compared with the most recent magnetic resonance imaging prior to vaccination. 42 Together, these outcomes indicate that in pwMS treated with DMF, there was no exacerbation of clinical or subclinical disease activity post-vaccination.…”

“…42 In addition, in the 4 weeks following vaccination, there were no relapses, neurological deteriorations, or gadolinium-enhancing lesions, while 80% (n = 16 out of 20) of patients showed no new/newly enlarging lesions compared with the most recent magnetic resonance imaging prior to vaccination. 42 Together, these outcomes indicate that in pwMS treated with DMF, there was no exacerbation of clinical or subclinical disease activity post-vaccination. 42 In addition to concerns about vaccine-induced relapses, general tolerability may also be of concern for those who are considering vaccination.…”

“…In addition, no significant differences were observed in sNfL level between people on DMF and healthy controls. 42 Following COVID-19 infection in two healthy controls and one pwMS, sNfL levels increased by more than 10 pg/ml in both control participants, but remained stable in the patient on DMF. 42 An open-label study of patients receiving DMF or IFN for treatment of MS evaluated the immune response to three vaccines: tetanus-diphtheria toxoid to assess T-cell-dependent humoral response; pneumococcal 23-polyvalent vaccine to assess T-cell-independent humoral response; and meningococcal oligosaccharide CRM 197 conjugate to assess T-cell-dependent neoantigen response.…”

“…42 Following COVID-19 infection in two healthy controls and one pwMS, sNfL levels increased by more than 10 pg/ml in both control participants, but remained stable in the patient on DMF. 42 An open-label study of patients receiving DMF or IFN for treatment of MS evaluated the immune response to three vaccines: tetanus-diphtheria toxoid to assess T-cell-dependent humoral response; pneumococcal 23-polyvalent vaccine to assess T-cell-independent humoral response; and meningococcal oligosaccharide CRM 197 conjugate to assess T-cell-dependent neoantigen response. 43 Between DMF and IFN groups, responder rates (≥2-fold rise in anti-tetanus serum immunoglobulin G [IgG] levels) were comparable for all tested vaccines and no meaningful differences were observed between groups when stratified by age category or lymphocyte count.…”

Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method

“…journals.sagepub.com/home/tan 13 AE profiles of the influenza and COVID-19 vaccines have not been shown to be influenced by DMF. 29,87,172,173 DMF does not interact with vaccines for COVID-19 and patients taking DMF should continue therapy, independent of vaccination timing. 29,167 Data attained with influenza vaccination suggest that vaccine use does not increase the risk of subclinical disease activity in DMF-treated patients.…”