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Is vaccine response to SARS-CoV-2 preserved after switching to anti-CD20 therapies in patients with multiple sclerosis or related disorders?

Author information

Affiliations

  • 1. Department of Neurology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.
      Authors
    • Jeantin L 1
    • Maillart E 1
    • Beigneux Y 1
    (3 authors)
  • 2. Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, laboratoty of virology, Paris, France.
      Authors
    • Abdi B 2
    • Soulié C 2
    • Marcelin AG 2
    (3 authors)
  • 3. Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Département d'Immunologie, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France.
      Authors
    • Sterlin D 3
    (1 author)
  • 4. Sorbonne Université, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC neurosciences, Paris, France.
      Authors
    • Hippolyte A 4
    • Louapre C 4, 7
    (2 authors)
  • 5. Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Département de Santé Publique, Unité de Recherche Clinique Pitié-Salpêtrière-Charles Foix, Paris, France.
      Authors
    • Belin L 5
    (1 author)
    • Show all (7)

ORCIDs linked to this article

Journal of Neurology, Neurosurgery, and Psychiatry, 14 Dec 2023, 95(1):19-28
https://doi.org/10.1136/jnnp-2023-331770 PMID: 37479463 

Abstract 

Background

Although vaccination against SARS-CoV-2 is recommended prior to introducing anti-CD20 therapies, limited data are available regarding the evolution of post-vaccinal immunity.

Methods

This retrospective study compared anti-Spike antibody titres at 6 and 12 months from SARS-CoV-2 vaccination between patients vaccinated before switching to anti-CD20 ('Switch') and two control groups: (1) patients vaccinated under disease-modifying therapies (DMTs) other than fingolimod and anti-CD20 ('Other DMTs'); (2) patients vaccinated on anti-CD20 ('Anti-CD20'). Anti-Spike-specific T-cell responses were compared between 'Switch' and 'Anti-CD20' groups.

Results

Fifty-three patients were included in the 'Switch' group, 54 in the 'Other DMTs' group and 141 in the 'Anti-CD20' group. At 6 months, in the subset of patients who received a booster dose, the 'Switch' group had lower anti-Spike titres compared with the 'Other DMTs' group (median 241.0 IQR (88.0; 504.0) BAU/mL vs 2034 (1155; 4634) BAU/mL, p<0.001), and less patients in the 'Switch' group reached the protective threshold of 264 BAU/mL. The 'Switch' group had higher anti-Spike titres than the 'Anti-CD20' group (7.5 (0.0; 62.1) BAU/mL, p=0.001). Anti-Spike titres were not different between the 'Switch' and 'Other DMTs' groups before booster administration. These results were similar at 12 months. Spike-specific T-cell positivity was similar between the 'Switch' and 'Anti-CD20' groups at 6 and 12 months (60.4% vs 61.0%, p=0.53, and 79.4% vs 87.5%, p=0.31, respectively).

Conclusions

Despite a primary vaccination performed before the first anti-CD20 cycle, our results suggest weaker immune responses at 6 and 12 months and decreased booster efficacy after introducing anti-CD20. Patients vaccinated prior to anti-CD20 introduction might falsely be considered as fully protected by vaccination.

Full text links 

Read article at publisher's site: https://doi.org/10.1136/jnnp-2023-331770

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    Funding 

    Funders who supported this work.

    Assistance Publique – Hôpitaux de Paris (1)

    Fondation de France (1)

    Fédération Internationale de l&apos;Automobile (1)

    Roche (1)