mRNA COVID-19 vaccines effective in patients with MS on disease-modifying therapies

Messenger RNA COVID-19 vaccination was effective among most patients with MS who used various disease-modifying therapies, according to study results published in Neurology.

However, the extent of protection appeared to differ based on the medication used.

“Our study aimed to focus on patients with MS, representatives of part of the population with an overall increased risk for serious COVID-19 outcome compared with healthy individuals, due to the treatment with different immunomodulatory or immunosuppressive medications,” Delia Goletti, MD, PhD, of the Translational Research Unit at the National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS in Italy, told Healio Neurology. “We evaluated the impact of therapeutic regimens used in MS patients to mount a coordinated serological and T-cell-specific immune response to SARS-CoV-2 after a month from the complete mRNA-based vaccination.”

Using two parallel prospective studies conducted in Italy, the researchers enrolled health care workers (n = 78) and patients with MS (n = 108) who completed the two-dose schedule of an mRNA-based vaccine against COVID-19 in the past 2 to 4 weeks. They examined serological response via quantification of the region-binding domain (RBD) and neutralizing antibodies. They used a whole-blood test quantifying interferon (IFN)-gamma response to spike peptides to analyze cell-mediated response. They used fluorescence-activated cell sorting analysis to pinpoint cells that responded to spike stimulation. Among patients with MS, 28 were treated with IFN-beta, 35 with fingolimod, 20 with cladribine and 25 with ocrelizumab.

Results showed a lower anti-RBD-antibody response rate among patients treated with ocrelizumab (40%; P < .0001) and fingolimod (85.7%; P = .0023) compared with health care workers and patients treated with cladribine or IFN-beta. Patients treated with ocrelizumab (P < .0001), fingolimod (P < .0001) and cladribine (P = .01) had lower anti-RBD-antibody median titer than health care workers and patients treated with IFN-beta.

All tested health care workers but only 16.6% of patients treated with fingolimod had serum neutralizing activity present. The researchers detected T-cell-specific response among 62% of patients with MS, although IFN-gamma levels were significantly lower compared with health care workers. They observed the lowest frequency of T-cell response among patients treated with fingolimod (14.3%). Goletti and colleagues noted a correlation between T-cell-specific response and lymphocyte count and anti-RBD antibody titer. CD4+ and CD8+ T-cells mediated IFN-gamma T-cell response.

“Evaluating the efficacy of anti-SARS-CoV-2 vaccination in people with MS is of great scientific and clinical interest for optimizing the clinical management of these patients during the current COVID-19 pandemic,” Goletti said. “In the present study, we demonstrated that COVID 19 vaccines induce a humoral and/or cell-mediated-specific immunity in most of the patients with MS, although with different extent and this was related to the treatment used. These results do promote COVID-19 vaccination in MS patients.”