In most patients with multiple sclerosis (MS) treated with different disease-modifying drugs, COVID-19 messenger ribonucleic acid (mRNA) vaccines induce humoral and cell-mediated specific immune responses against spike peptides, according to study results published in the journal Neurology.

As limited data exist on the effect of disease-modifying drugs used in MS on the humoral and cell-mediated immune responses to SARS-CoV-2 vaccine, the current study aimed at determining COVID-19 mRNA vaccines efficacy and immune-specific response of patients with MS treated with various disease-modifying drugs.

The study sample included health care workers and patients with MS who completed the 2-dose schedule of an mRNA-based vaccine against SARS-CoV-2 in the last 2-4 weeks. 


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The anti-Region Binding Domain (RBD) neutralizing antibodies and spike-specific T-cell response were used to evaluate serological response after the full vaccination of MS patients treated with various disease-modifying drugs. Evaluation of interferon (IFN)-γ response to spike peptides was used to assess T-cell response by flow cytometry.

The study sample included 78 health care workers (median age, 44 years; 20 men) and 108 patients with MS (median age, 47 years; 34 men). The most common disease-modifying drugs for MS were fingolimod (35 patients) and IFN-β (28 patients), followed by ocrelizumab (25 patients), and cladribine (20 patients).

A detectable anti-RBD antibody response was observed in all health care workers and in 80.5% of patients with MS. While a detectable anti-RBD response was recorded in all cladribine-treated patients (100%) and in almost all patients treated with IFN-β (96.4%) or fingolimod (85.7%), this response was evident in only 40% of ocrelizumab-treated patients. Patients treated with ocrelizumab or fingolimod showed lower response rates compared to health care workers (P <.0001 and P =.0023, respectively).

The quantitative specific response varied according to the ongoing drug treatment, as the anti-RBD antibody median titer was significantly lower in patients with MS treated with ocrelizumab, fingolimod, and cladribine, compared with health care workers. In IFN-β-treated patients there was no difference in the serological median titer compared with health care workers.

While IFN-γ response to spike peptides was recorded in all health care workers, the T-cell response was evident in 67 patients (62%) with MS and IFN-γ levels were significantly lower compared with health care workers. T-cell response was most common with ocrelizumab (92%) and IFN-β (89.3%), and lower with cladribine (70%) and fingolimod (14.3%).

In health care workers, IFN-γ T-cell specific response was mediated by CD4+ and CD8+ T cells, while in patients with MS the response was mediated only by CD4+ T cells.

The study had several limitations, including the small sample size, assessment of immune response at a single time point following vaccination, and T-cell response was determined based on the measurement of IFN-γ unlike prior studies evaluating additional T-helper 1 cytokines.

“This study provides Class III data that COVID mRNA vaccination induces both humoral and cell-mediated specific immune responses against viral spike proteins in a majority of MS patients,” concluded the researchers.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Tortorella C, Aiello A, Gasperini C, et al. Humoral- and T-cell-specific immune responses to SARS-CoV-2 mRNA vaccination in patients with MS using different disease-modifying therapies. Neurology. Published online November 22, 2021. doi: 10.1212/WNL.0000000000013108