Multiple Sclerosis, Disease-Modifying Therapies and COVID-19: A Systematic Review on Immune Response and Vaccination Recommendations.

Verónica Cabreira,Ricardo Soares-Dos-Reis,Pedro Abreu,Maria José Sá,Joana Guimarães

doi:10.3390/vaccines9070773

Abstract

Understanding the risks of COVID-19 in patients with Multiple Sclerosis (MS) receiving disease-modifying therapies (DMTs) and their immune reactions is vital to analyze vaccine response dynamics. A systematic review on COVID-19 course and outcomes in patients receiving different DMTs was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Emerging data on SARS-CoV-2 vaccines was used to elaborate recommendations. Data from 4417 patients suggest that MS per se do not portend a higher risk of severe COVID-19. As for the general population, advanced age, comorbidities, and higher disability significantly impact COVID-19 outcomes. Most DMTs have a negligible influence on COVID-19 incidence and outcome, while for those causing severe lymphopenia and hypogammaglobulinemia, such as anti-CD20 therapies, there might be a tendency of increased hospitalization, worse outcomes and a higher risk of re-infection. Blunted immune responses have been reported for many DMTs, with vaccination implications. Clinical evidence does not support an increased risk of MS relapse or vaccination failure, but vaccination timing needs to be individually tailored. For cladribine and alemtuzumab, it is recommended to wait 3–6 months after the last cycle until vaccination. For the general anti-CD20 therapies, vaccination must be deferred toward the end of the cycle and the next dose administered at least 4–6 weeks after completing vaccination. Serological status after vaccination is highly encouraged. Growing clinical evidence and continuous surveillance are extremely important to continue guiding future treatment strategies and vaccination protocols.

Highlights

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome caused by a variant of coronavirus (SARS-CoV-2)
After selecting the articles related to the first part of this review, we looked for articles on ‘Multiple Sclerosis’; ‘COVID-19’; ‘SARS-CoV-2’; ‘vaccines’ and ‘vaccination’ to analyze the immune response dynamics to vaccines on Multiple sclerosis (MS) patients
Our study is a contemporary review of COVID-19 data in MS patients throughout April 2021, when vaccination campaigns have started across the globe

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome caused by a variant of coronavirus (SARS-CoV-2). It emerged in December 2019, in the Wuhan province and rapidly spread worldwide [1]. Since the outbreak of the pandemic, in addition to the well-known COVID-19 symptoms, including neurological ones [1], there has been a concern with populations facing a higher risk of infection [3]. Multiple sclerosis (MS) patients are usually under disease modifying therapies (DMTs) and have been identified as a high-risk population, both because inflammation is an integral part of MS pathogenesis, and infections are well known exacerbation triggers of MS-related disease activity [4]

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