COVID-19 infection after SARS-CoV-2 mRNA vaccination in Multiple Sclerosis, AQP4-antibody NMOSD and MOGAD during the Omicron BA.1/2 wave in Singapore (P12-3.002)

Abstract

<h3>Objective:</h3> To determine the factors associated with breakthrough COVID-19 infection despite at least two SARS-CoV-2 mRNA vaccines in multiple sclerosis (MS), aquaporin-4 neuromyelitis optica spectrum disorder (AQP4-Ab NMOSD) and myelin oligodendrocyte glycoprotein-antibody associated disease (MOGAD) patients during the Omicron BA.1/2 wave in Singapore. <h3>Background:</h3> While SARS-CoV-2 Omicron variant appears to cause mild disease, its high transmissibility remains a concern amongst people with neuroimmunological diseases, especially those on disease-modifying therapies (DMTs). <h3>Design/Methods:</h3> We performed a prospective study at the National Neuroscience Institute (NNI), Singapore during the Omicron BA.1/2 wave from January to April 2022. Data (demographics, disease history, DMTs, vaccination records and COVID-19 infection status) was collected via clinic and/or teleconsultation from January to August 2022. <h3>Results:</h3> Two hundred and one patients were included – 125 MS, 65 AQP4-Ab NMOSD, and 11 MOGAD. Forty-seven had COVID-19 infection of whom 14 were on anti-CD20 therapies and 4 on fingolimod. Two infections were of moderate severity while the rest were mild. Anti-CD20 therapies and fingolimod were associated with COVID-19 infection (p=0.039) while the other DMTs were not. On survival analysis, time to infection after 3 vaccinations was shorter in anti-CD20 therapies and fingolimod (as a group) compared to other DMTs (HR 2.96, p=0.006) and to no DMTs (HR 2.74, p=0.025). Receipt of a third dose of vaccine was associated with fewer infections (33/176, 18.8%; crude rate of 11.3 infections per 1000 person-years) compared to 2 doses only (14/25, 56.0%; crude rate of 21.8 infections per 1000 person-years) (p&lt;0.0001). <h3>Conclusions:</h3> Patients on anti-CD20 therapies and fingolimod are still at increased risk of COVID-19 infection after SARS-CoV-2 mRNA vaccinations although the majority of infections are mild. Receipt of a third dose confers additional protection, supporting the vaccination strategy in this group of patients. <b>Disclosure:</b> Dr. Tan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Tan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viela Bio. Dr. Tan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Ms. Tye has nothing to disclose. Ms. Peng has nothing to disclose. Dr. Wong has nothing to disclose. The institution of Dr. Yeo has received personal compensation in the range of $0-$499 for serving as a Consultant for Edanz Pharma. The institution of Dr. Yeo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. The institution of Dr. Yeo has received personal compensation in the range of $0-$499 for serving as a Consultant for Novartis . The institution of Dr. Yeo has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Terumo BCT. The institution of Dr. Yeo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Euroimmun AG . The institution of Dr. Yeo has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck. The institution of Dr. Yeo has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis . The institution of Dr. Yeo has received research support from National Medical Research Council (Singapore) . The institution of Dr. Yeo has received research support from Roche .