Real-world COVID-19 immunity in multiple sclerosis (CoVaR-MS): A longitudinal follow up study

Area of Science:

• Immunology
• Neurology
• Vaccinology

Background:

• Multiple Sclerosis (MS) patients on disease-modifying treatments (DMTs) present unique challenges for COVID-19 immunity assessment.
• Variability in immunosuppression necessitates real-world data on vaccine effectiveness in this population.

Purpose of the Study:

• To evaluate persistent serological and cellular immunity following COVID-19 vaccination in people with MS (PwMS) compared to healthy volunteers (HV).
• To analyze the impact of specific DMTs on COVID-19 immunity over time.

Main Methods:

• A longitudinal, real-world study involving 205 PwMS (on various DMTs including Alemtuzumab, Dimethyl fumarate, Fingolimod, Interferon, Natalizumab, Ocrelizumab, or no DMT) and 30 HV.
• Serological and cellular immunity assays conducted at <=18 and <=24 months post-vaccination course.
• Statistical analysis to compare immunity levels and adverse event incidence between groups.

Main Results:

• High rates of immunity (97% at <=18 months, 96.9% at <=24 months) observed in both PwMS and HV.
• PwMS on Ocrelizumab showed reduced serological immunity but maintained cellular immunity; Fingolimod significantly lowered both.
• Other DMT groups exhibited comparable immunity to HV; adverse event rates were similar across all groups.

Conclusions:

• COVID-19 vaccination elicits durable immunity in most PwMS, but DMTs like Fingolimod and Ocrelizumab can modulate immune responses.
• Data support the recommendation for COVID-19 vaccine boosters in PwMS, particularly those on Ocrelizumab and Fingolimod.
• Understanding DMT-specific immune responses is crucial for optimizing vaccination strategies in MS patients.