Breakthrough SARS-CoV-2 infections in MS patients on disease-modifying therapies. (November 2022)

• Record Type: Journal Article
• Authors: Schiavetti, Irene; Cordioli, Cinzia; Stromillo, Maria Laura; Teresa Ferrò, Maria; Laroni, Alice; Cocco, Eleonora; Cola, Gaia; Pasquali, Livia; Rilla, Maria Teresa; Signoriello, Elisabetta; Iodice, Rosa; Di Sapio, Alessia; Lanzillo, Roberta; Caleri, Francesca; Annovazzi, Pietro; Conte, Antonella; Liberatore, Giuseppe; Ruscica, Francesca; Docimo, Renato; Bonavita, Simona; Ulivelli, Monica; Cavalla, Paola; Patti, Francesco; Ferraro, Diana; Clerico, Marinella; Immovilli, Paolo; Di Filippo, Massimiliano; Salvetti, Marco; Sormani, Maria Pia
• Is Part Of: Multiple sclerosis. Volume 28:Number 13(2022)
• Page Start: 2106
• Page End: 2111
• Publication Date: 2022-11
• Subjects: Multiple sclerosis -- COVID-19 vaccination -- breakthrough infections; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/13524585221102918
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: Patients with multiple sclerosis (pwMS) treated with anti-CD20 or fingolimod showed a reduced humoral response to SARS-CoV-2 vaccines. Objective: In this study we aimed to monitor the risk of breakthrough SARS-CoV-2 infection in pwMS on different disease-modifying therapies (DMTs). Methods: Data on the number of vaccinated patients and the number of patients with a breakthrough infection were retrospectively collected in 27 Italian MS centers. We estimated the rate of breakthrough infections and of infection requiring hospitalization per DMT. Results: 19, 641 vaccinated pwMS were included in the database. After a median follow-up of 8 months, we observed 137 breakthrough infections. Compared with other DMTs, the rate of breakthrough infections was significantly higher on ocrelizumab (0.57% vs 2.00%, risk ratio (RR) = 3.55, 95% CI = 2.74–4.58, p < 0.001) and fingolimod (0.58% vs 1.62%, RR = 2.65, 95% CI = 1.75–4.00, p < 0.001), while there were no significant differences in any other DMT group. In the ocrelizumab group the hospitalization rate was 16.7% versus 19.4% in the pre-vaccination era (RR = 0.86, p = 0.74) and it was 3.9% in all the other DMT groups versus 11.9% in the pre-vaccination period (RR = 0.33, p = 0.02). Conclusions: The risk of breakthrough SARS-CoV-2 infections is higher in patients treated with ocrelizumab and fingolimod, and the rate of severe infections was significantly reduced in all the DMTs excluding ocrelizumab.