Effect of different disease-modifying therapies on humoral response to BNT162b2 vaccine in Sardinian multiple sclerosis patients

  1. Maristella Pitzalis
  2. Maria Laura Idda
  3. Valeria Lodde
  4. Annalisa Loizedda
  5. Monia Lobina
  6. Magdalena Zoledzwieska
  7. Francesca Virdis
  8. Giuseppe Delogu
  9. Federica Pirinu
  10. Maria Giuseppina Marini
  11. Maura Mingoia
  12. Jessica Frau
  13. Lorena Lorefice
  14. Maria Fronza
  15. Daniele Carmagini
  16. Elisa Carta
  17. Valeria Orrù
  18. Sergio Uzzau
  19. Paolo Solla
  20. Federica Loi
  21. Marcella Devoto
  22. Maristella Steri
  23. Edoardo Fiorillo
  24. Matteo Floris
  25. Ignazio Roberto Zarbo
  26. Eleonora Cocco
  27. Francesco Cucca
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Abstract

Objectives

Vaccination against COVID-19 is highly recommended to patients affected by multiple sclerosis (MS); however, the impact of MS disease-modifying therapies (DMTs) on the immune response following vaccination has been only partially investigated. Here, we aimed to elucidate the effect of DMTs on the humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines in MS patients.

Methods

We obtained sera from 912 Sardinian MS patients and 63 healthy controls 30 days after the second dose of BNT162b2 vaccine and tested them for SARS-CoV-2 response using anti-Spike (S) protein-based serology. Previous SARS-CoV-2 infection was assessed by anti-Nucleocapsid (N) serology. Patients were either untreated or undergoing treatment with a total of 13 different DMTs. Differences between treatment groups comprised of at least 10 patients were assessed by generalized linear mixed-effects model. Demographic and clinical data and smoking status were analyzed as additional factors potentially influencing humoral immunity from COVID-19 vaccine.

Results

MS patients treated with natalizumab, teriflunomide, azathioprine, fingolimod, ocrelizumab, and rituximab showed significantly lower humoral responses compared to untreated patients. We did not observe a statistically significant difference in response between patients treated with the other drugs (dimethyl fumarate, interferon, alemtuzumab and glatiramer acetate) and untreated patients. In addition, older age, male, sex and active smoking were significantly associated with lower antibody titers against SARS-CoV-2. MS patients previously infected with SARS-CoV-2 had significantly higher humoral responses to vaccine than uninfected patients.

Conclusion

Humoral response to BNT162b2 is significantly influenced by the specific DMTs followed by patients, as well as by other factors such as previous SARS-CoV-2 infection, age, sex, and smoking status. These results are important to inform targeted strategies to prevent clinically relevant COVID-19 in MS patients.

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