A multicenter, prospective cohort study on the anti-SARS-CoV-2 vaccination response in patients with multiple sclerosis in Germany.

BACKGROUND

This epidemiologic cohort study documented clinical and serological data in MS patients over several vaccination cycles against severe respiratory syndrome coronavirus-2 (SARS-CoV-2) in a real-world setting.

METHODS

Adult patients with MS were included during a period of 26 months from July 2021 if SARS-CoV-2 vaccination was planned, or first dose was given, or vaccination was completed within the last 6 weeks, or vaccination was completed >6 weeks ago and a booster dose was planned within the next 90 days. Humoral immune response to authorized SARS-CoV-2 vaccines was investigated during each vaccination cycle at baseline and approximately 1 and 6 months after vaccination. Immune response was defined as an anti-SARS-CoV-2 spike protein IgG titer >100 BAU/ml above pre-vaccination level and, separately, by the presence of SARS-CoV-2 neutralizing antibodies (NAb) approximately 1 month after the last vaccination.

RESULTS

Of 159 patients enrolled, 140 (88.1%) were being treated with a DMT. Most patients (67.9%, n = 108) entered the study after complete initial SARS-CoV-2 vaccination (up to two doses) and before the 1st booster dose. Approximately 1 month after the 1st booster vaccination, response was seen in 68.1% of the patients (n = 79/116) based on anti-S1-IgG increase and in 72.1% (n = 88/122) based on NAb seropositivity. Persisting immune response approximately 6 months after vaccination was observed in 71.8% (n = 51/71) and in 93.7% (n = 74/79) of the responders, respectively. Adequate humoral immune response and persistence of response was less frequent in patients on anti-CD20 antibodies or sphingosine-1-phosphate receptor (S1PR) modulators compared to patients on other DMTs or DMT-untreated patients. Breakthrough infections with the SARS-CoV-2 virus were reported in 58 patients (36.5%). Seven patients (4.4%) experienced an MS relapse during the study period.

CONCLUSIONS

With the exception of anti-CD20 antibodies and S1PR modulators, DMTs did not impair humoral response to any of the authorized SARS-CoV-2 vaccines. Persistence of humoral immune response was seen over a period of at least 3 months in the majority of initial responders but was decreased in the anti-CD20 antibodies/S1PR modulator subgroup.

CLINICAL TRIAL REGISTRATION: This epidemiological study is registered in the German Clinical Trials Register (DRKS00025893).