Celia Oreja-Guevara, MD, PhD, University Hospital San Carlos, Madrid, Spain, discusses the findings of a prospective study assessing COVID-19 vaccination and humoral immune response in people with multiple sclerosis (MS). Demographic characteristics, adverse responses, and SARS-CoV-2 antibody titers were analysed in 165 patients with MS. Most notably, no increase of relapse activity was observed in vaccinated patients. Humoral immune responses to vaccination were comparable to healthy controls in most cases, excluding individuals receiving rituximab or ocrelizumab who did not develop a successful post-vaccination humoral response. Immune responses in patients receiving fingolimod were varied, ranging from no response to the same response as healthy controls. Dr Oreja-Guevara discusses the implication of these findings for MS patients, particularly those receiving anti-CD20 therapy. This interview took place at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) congress 2021.
Transcript (edited for clarity)
We have analyzed more than 300 patients and we have presented in the ECTRIMS the results of a 165 patients. We have examined the humoral response against the COVID vaccination. And from this 165 patients, we have 120 vaccinated with Moderna or Pfizer and only 42 with AstraZeneca and three with Janssen. So the main results are with the mRNA vaccination because we have 120. And there was a very important thing, that was this general thing...
We have analyzed more than 300 patients and we have presented in the ECTRIMS the results of a 165 patients. We have examined the humoral response against the COVID vaccination. And from this 165 patients, we have 120 vaccinated with Moderna or Pfizer and only 42 with AstraZeneca and three with Janssen. So the main results are with the mRNA vaccination because we have 120. And there was a very important thing, that was this general thing. Patients with MS which were vaccinated, they have no increase in relapses. So that is very important. So vaccinated patients with MS, they don’t have more relapses than before. Yeah. So that is one important thing. The second thing is that these vaccinations are so safe for MS patients as for the healthy population.
And in our study, we have compared the results of the 165 patients with the controls of the hospital. We, the healthcare professionals, we were the control group, and we have compare our results with the results of the MS patients. The most important results were that treatments like interferon beta, glatiramer acetate, cladribine, teriflunomide, dimethyl fumarate and natalizumab have no interactions with the vaccination. It means patients treated with all these treatments, they have a very similar humoral response than the healthy population, so that we have seen their data and the antibodies data for these patients are very similar to the healthy controls. There was no differences between. So that means that there are no interactions between all these treatments and the vaccination. All these patients, they can do a very good humoral response.
The other important part is which treatments they don’t allow to have a very good humoral response. We have seen the anti-CD20 and we have five patients with rituximab. And we have vaccinated these patients and all of them, they have no antibodies. They have no humoral response. We have 20 patients with the ocrelizumab and only three of these 20 patients they have a humoral response. Probably because two of them, they were one year without ocrelizumab, so that they have enough time to recover the B-cells and the immunoglobulins and probably that was the reason why they have a very good humoral response. And the other patient that was a woman that was with COVID, very severe COVID in the first wave and she was hospitalized. So that probably she has enough antibodies against COVID because of the hospitalization and the severe COVID and was the reason why she has produced again, antibodies against the vaccination. So with the exception of these three cases, the other patients, they have a very low or no humoral response. And probably it’s because of the no B-cells or the reductions of the immunoglobulins.
The other interesting part is that we have some patients with ofatumumab that is also an anti-CD20. These patients, five of them, they have adequate humoral response. Not so high, like for example with interferon or a healthy controls, but enough. So around 2000, 3000 antibodies, and only one has no response. And probably it’s because it’s a little different the mechanism of ofatumumab and ocrelizumab. Ofatumumab is every four weeks and the B-cells, they are not completely depleted. The important thing that we have seen is that when we have a very long interval between the ocrelizumab and the vaccination, the patients can have a humoral response. So that the key is to leave a very long interval when this is possible. And for example, we are trying now to do the third dose of the ocrelizumab after six months of the last dose of ocrelizumab. We try to delay a little the ocrelizumab to have the vaccination and to have a humoral response.
And the last one important was about the fingolimod. So the S1P receptors. And we have seen that the humoral response of these patients is very variable. We have patients with no humoral response, we have patients with a low humoral response, but enough to fight against COVID, and we have patients with a completely normal response. From these five patients that they have a completely humoral response, three, they have COVID, but the other two, they have no COVID and they were no relation with lymphopenia or with other factors. So that really in fingolimod is not very clear why some patients they are doing antibodies and why they don’t do in other cases. And we have seen that there are no relations with lymphopenia or with the duration of the disease or with the duration of the treatment.
And to conclude our results is that say most of the treatment, so interferon, glatiramer acetate, cladribine, teriflunomide, dimethyl fumarate and natalizumab, they don’t interact with the vaccination so that these patients, they can do a normal, adequate humoral response. And for the patients with the anti-CD20 that they are not doing the response, we should think about to perhaps delay the interval between vaccination and treatment.
In the EAN-ECTRIMS vaccination session, we will speak about all the vaccinations, because we have spoken not only about COVID, we have spoken about yellow fever, human papillomavirus vaccination and other vaccinations that are also very important for multiple sclerosis patients. And we, of course, we speak about the COVID vaccination and in all of them, we try to find the best moment to do the vaccination, not only for the COVID. We will explain, this recommendation is not published, but we will give some of the recommendations about this. So about timing with all the vaccination, not only with the COVID.
Celia Oreja-Guevara has received speaker and consultation fees from Biogen Idec, Celgene, Sanofi-Genzyme, Novartis, Roche, Merck, and Teva.