Humoral immunity to SARS-CoV-2 mRNA vaccination in multiple sclerosis: the relevance of time since last rituximab infusion and first experience from sporadic revaccinations
IntroductionThe effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.ObjectiveTo characterise humoral immunity after mRNA-COVID-19 vaccination of people with...
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| Published in | Journal of neurology, neurosurgery and psychiatry Vol. 94; no. 1; pp. 19 - 22 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group Ltd
01.01.2023
BMJ Publishing Group LTD BMJ Publishing Group |
| Series | Short report |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0022-3050 1468-330X 1468-330X |
| DOI | 10.1136/jnnp-2021-327612 |
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| Abstract | IntroductionThe effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.ObjectiveTo characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).MethodsAll pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3–12 weeks after full vaccination, and compared with healthy subjects.Results528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.ConclusionsPatients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations. |
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| AbstractList | The effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.INTRODUCTIONThe effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.To characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).OBJECTIVETo characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).All pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3-12 weeks after full vaccination, and compared with healthy subjects.METHODSAll pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3-12 weeks after full vaccination, and compared with healthy subjects.528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.RESULTS528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.Patients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations.CONCLUSIONSPatients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations. The effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic. To characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS). All pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3-12 weeks after full vaccination, and compared with healthy subjects. 528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response. Patients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations. IntroductionThe effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.ObjectiveTo characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).MethodsAll pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3–12 weeks after full vaccination, and compared with healthy subjects.Results528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.ConclusionsPatients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations. |
| Author | Lund-Johansen, Fridtjof Nygaard, Gro Owren Andersen, Jan Terje Berge, Tone Schikora-Rustad, Stine Vaage, Eline Benno Munthe, Ludvig Andre Vaage, John Torgils Aaberge, Ingeborg Aase S Mygland, Åse Holmøy, Trygve Lorentzen, Åslaug Rudjord Tran, The Trung Torgauten, Hilde Marie Wergeland, Stig Myhr, Kjell-Morten Aarseth, Jan Celius, Elisabeth Gulowsen König, Marton Torkildsen, Øivind Harbo, Hanne Flinstad Søraas, Arne |
| AuthorAffiliation | 2 Department of Neurology , Sørlandet Sykehus HF , Kristiansand , Norway 12 Department of Mechanical, Electronic and Chemical Engineering , Oslo Metropolitan University , Oslo , Norway 3 The Norwegian National Advisory Unit on Tick-borne Diseases , Arendal , Norway 10 Department of Neurology , Akershus University Hospital , Lorenskog , Norway 1 Department of Neurology , Oslo University Hospital , Oslo , Norway 14 Department of Pharmacology , Oslo University Hospital , Oslo , Norway 7 Department of Neurology , Haukeland University Hospital , Bergen , Norway 8 Norwegian MS Registry and Biobank , Haukeland University Hospital , Bergen , Norway 11 Institute of Clinical Medicine , University of Oslo , Oslo , Norway 15 K.G. Jebsen Centre for B cell malignancies , University of Oslo , Oslo , Norway 13 Department of Research, Innovation and Education, Division of Clinical Neuroscience , Oslo University Hospital , Oslo , Norway 6 Department of Immunology , Oslo University Hospital , Oslo , Norway 9 Departm |
| AuthorAffiliation_xml | – name: 15 K.G. Jebsen Centre for B cell malignancies , University of Oslo , Oslo , Norway – name: 2 Department of Neurology , Sørlandet Sykehus HF , Kristiansand , Norway – name: 8 Norwegian MS Registry and Biobank , Haukeland University Hospital , Bergen , Norway – name: 1 Department of Neurology , Oslo University Hospital , Oslo , Norway – name: 5 Institute of Clinical Medicine , University of Bergen , Bergen , Norway – name: 10 Department of Neurology , Akershus University Hospital , Lorenskog , Norway – name: 7 Department of Neurology , Haukeland University Hospital , Bergen , Norway – name: 9 Department of Infectious Disease Immunology , Norwegian Institute of Public Health , Oslo , Norway – name: 13 Department of Research, Innovation and Education, Division of Clinical Neuroscience , Oslo University Hospital , Oslo , Norway – name: 12 Department of Mechanical, Electronic and Chemical Engineering , Oslo Metropolitan University , Oslo , Norway – name: 16 Department of Microbiology , Oslo University Hospital , Oslo , Norway – name: 4 Neuro-SysMed, Department of Neurology , Haukeland University Hospital , Bergen , Norway – name: 11 Institute of Clinical Medicine , University of Oslo , Oslo , Norway – name: 3 The Norwegian National Advisory Unit on Tick-borne Diseases , Arendal , Norway – name: 14 Department of Pharmacology , Oslo University Hospital , Oslo , Norway – name: 6 Department of Immunology , Oslo University Hospital , Oslo , Norway |
| Author_xml | – sequence: 1 givenname: Marton orcidid: 0000-0001-6242-9804 surname: König fullname: König, Marton email: makoni@ous organization: Department of Neurology, Oslo University Hospital, Oslo, Norway – sequence: 2 givenname: Åslaug Rudjord surname: Lorentzen fullname: Lorentzen, Åslaug Rudjord organization: The Norwegian National Advisory Unit on Tick-borne Diseases, Arendal, Norway – sequence: 3 givenname: Hilde Marie surname: Torgauten fullname: Torgauten, Hilde Marie organization: Institute of Clinical Medicine, University of Bergen, Bergen, Norway – sequence: 4 givenname: The Trung surname: Tran fullname: Tran, The Trung organization: Department of Immunology, Oslo University Hospital, Oslo, Norway – sequence: 5 givenname: Stine surname: Schikora-Rustad fullname: Schikora-Rustad, Stine organization: Department of Neurology, Sørlandet Sykehus HF, Kristiansand, Norway – sequence: 6 givenname: Eline Benno surname: Vaage fullname: Vaage, Eline Benno organization: Department of Immunology, Oslo University Hospital, Oslo, Norway – sequence: 7 givenname: Åse surname: Mygland fullname: Mygland, Åse organization: Institute of Clinical Medicine, University of Bergen, Bergen, Norway – sequence: 8 givenname: Stig surname: Wergeland fullname: Wergeland, Stig organization: Norwegian MS Registry and Biobank, Haukeland University Hospital, Bergen, Norway – sequence: 9 givenname: Jan surname: Aarseth fullname: Aarseth, Jan organization: Norwegian MS Registry and Biobank, Haukeland University Hospital, Bergen, Norway – sequence: 10 givenname: Ingeborg Aase S surname: Aaberge fullname: Aaberge, Ingeborg Aase S organization: Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway – sequence: 11 givenname: Øivind surname: Torkildsen fullname: Torkildsen, Øivind organization: Department of Neurology, Haukeland University Hospital, Bergen, Norway – sequence: 12 givenname: Trygve surname: Holmøy fullname: Holmøy, Trygve organization: Institute of Clinical Medicine, University of Oslo, Oslo, Norway – sequence: 13 givenname: Tone surname: Berge fullname: Berge, Tone organization: Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway – sequence: 14 givenname: Kjell-Morten surname: Myhr fullname: Myhr, Kjell-Morten organization: Institute of Clinical Medicine, University of Bergen, Bergen, Norway – sequence: 15 givenname: Hanne Flinstad surname: Harbo fullname: Harbo, Hanne Flinstad organization: Institute of Clinical Medicine, University of Oslo, Oslo, Norway – sequence: 16 givenname: Jan Terje surname: Andersen fullname: Andersen, Jan Terje organization: Department of Pharmacology, Oslo University Hospital, Oslo, Norway – sequence: 17 givenname: Ludvig Andre surname: Munthe fullname: Munthe, Ludvig Andre organization: K.G. Jebsen Centre for B cell malignancies, University of Oslo, Oslo, Norway – sequence: 18 givenname: Arne surname: Søraas fullname: Søraas, Arne organization: Department of Microbiology, Oslo University Hospital, Oslo, Norway – sequence: 19 givenname: Elisabeth Gulowsen surname: Celius fullname: Celius, Elisabeth Gulowsen organization: Institute of Clinical Medicine, University of Oslo, Oslo, Norway – sequence: 20 givenname: John Torgils surname: Vaage fullname: Vaage, John Torgils organization: Department of Immunology, Oslo University Hospital, Oslo, Norway – sequence: 21 givenname: Fridtjof surname: Lund-Johansen fullname: Lund-Johansen, Fridtjof organization: Department of Immunology, Oslo University Hospital, Oslo, Norway – sequence: 22 givenname: Gro Owren surname: Nygaard fullname: Nygaard, Gro Owren organization: Department of Neurology, Oslo University Hospital, Oslo, Norway |
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| References_xml | – volume: 117 start-page: 25018 year: 2020 ident: R13 article-title: Systemic complement activation is associated with respiratory failure in COVID-19 hospitalized patients publication-title: Proc Natl Acad Sci U S A doi: 10.1073/pnas.2010540117 – volume: 13524585211026272 year: 2021 ident: R6 article-title: Increased rate of hospitalisation for COVID-19 among rituximab-treated multiple sclerosis patients: a study of the Swedish multiple sclerosis registry publication-title: Mult Scler doi: 10.1177/13524585211026272 – volume: 52 start-page: 971 year: 2020 ident: R16 article-title: Detection of SARS-CoV-2-Specific humoral and cellular immunity in COVID-19 convalescent individuals publication-title: Immunity doi: 10.1016/j.immuni.2020.04.023 – volume: 133 start-page: 1380 year: 2020 ident: R8 article-title: Treatment of multiple sclerosis: a review publication-title: Am J Med doi: 10.1016/j.amjmed.2020.05.049 – start-page: 1 year: 2021 ident: R15 article-title: 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| Snippet | IntroductionThe effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of... The effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount... |
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| SubjectTerms | Antibodies Antibodies, Viral Biobanks Blood & organ donations Coronaviruses COVID-19 COVID-19 - prevention & control COVID-19 vaccines COVID-19 Vaccines - therapeutic use Disease Fingolimod Hydrochloride - therapeutic use Humans Immunity (Disease) Immunity, Humoral Immunization, Secondary Immunoglobulin G immunology Immunotherapy Lymphocytes Monoclonal antibodies Multiple Sclerosis Multiple Sclerosis - drug therapy Pandemics Questionnaires Rituximab - therapeutic use RNA, Messenger SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Vaccination |
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| Title | Humoral immunity to SARS-CoV-2 mRNA vaccination in multiple sclerosis: the relevance of time since last rituximab infusion and first experience from sporadic revaccinations |
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