Abstract
With unclear characteristics of post-infection and post-vaccination immunity, the multiple sclerosis community lacks evidence to guide patients on their continued coronavirus disease 2019 (COVID-19) infection risk. As disease modifying treatments all modulate the immune system, we expect their use to alter acquired immunity to COVID-19, but the specific impact of individual treatments is unclear. To address this, we analyzed the patient and COVID-19 specific characteristics associated with post-infection humoral immunity in 58 patients with central nervous system (CNS) demyelinating disorders in the Boston metropolitan area. Univariate analysis of variance was performed using Mann Whitney U test for continuous variables, and Chi Square or Fisher Exact test for nominal variables. Univariate and stepwise multivariate nominal logistic regression identified clinical characteristics associated with COVID-19 specific nucleocapsid IgG antibody formation post-infection. Our cohort demonstrated a 42% post-infection seropositive rate with a significantly higher rate observed with shorter duration between infection and antibody collection and use of natalizumab over no/other treatment. Use of anti-CD20 treatments compared to no/other treatment was associated with a significantly lower rate of seropositivity. However, only shorter duration between infection and antibody collection as well as use of no/other treatment compared to anti-CD20 treatment were found to be independently associated with increased likelihood of post-infection seropositivity. Additionally, we demonstrate durability of antibody response up to 9 months in a small subset of patients. Thus, our data supports that patients with CNS demyelinating disorders regardless of DMT are able to form a measurable antibody response after COVID-19 infection, and that patients on anti-CD20 treatments form less robust immunity after COVID-19 infection.
Highlights
The evolving coronavirus disease 2019 (COVID-19) pandemic and availability of multiple COVID-19 vaccines have made it clear that the best solution to the COVID-19 pandemic is sustained immunity against the virus
We evaluated the clinical characteristics associated with COVID-19 IgG seropositivity in a cohort of 58 patients with central nervous system (CNS) demyelinating disorders and prior COVID-19 infection
Repeat measurements were only available for 10 seropositive patients as the number of repeat measurements was determined by patient desire for repeat testing to evaluate durability of antibody response
Summary
The evolving coronavirus disease 2019 (COVID-19) pandemic and availability of multiple COVID-19 vaccines have made it clear that the best solution to the COVID-19 pandemic is sustained immunity against the virus. Given the large number of patients with central nervous system (CNS) demyelinating disorders that require immunomodulatory or immunosuppressive medications, identifying the forms and duration of post-infection and post-vaccination immunity in specific subpopulations is critical to guide patient care. Several studies have demonstrated both humoral and cellular immunity are formed after COVID-19 infection in >90% of the general population, the duration remains debated [1–4]. Patients with multiple sclerosis (MS) and other CNS demyelinating disorders have been found in cohort studies to have an average rate of post-infection seropositivity between 41 and 80% [5–10]. Disease modifying therapy (DMT) likely impacts humoral immunity to COVID-19, with small studies suggesting blunted and shorter duration responses in patients on anti-CD20 monoclonal antibodies [5, 7, 9–11]. We currently lack sufficient data to guide patients, especially those that remain unvaccinated, on their likelihood of protective immunity post-infection
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