Washington University in St. Louis, Department of Neurology, St. Louis, MO, USA.
Washington University in St. Louis, Department of Neurology, St. Louis, MO, USA.
Mult Scler Relat Disord. 2020 Oct;45:102439. doi: 10.1016/j.msard.2020.102439. Epub 2020 Aug 1.
Development of long-term immunologic memory relies upon humoral and cellular immune responses. Vaccinations aim to stimulate these responses against pathogens. Several studies have evaluated the impact of multiple sclerosis disease-modifying therapies on immune response to vaccines. Findings from these studies have important implications for people with multiple sclerosis who require vaccination and are using disease-modifying therapies.
Searches using PubMed and other engines were conducted in May 2020 to collect studies evaluating the impact of various disease-modifying therapies on immune responses to vaccination.
Several studies demonstrated preserved immune responses in people treated with beta-interferons to multiple vaccine types. Limited data suggest vaccine responses to be preserved with dimethyl fumarate treatment, as well. Vaccine responses were reduced to varying degrees in those treated with glatiramer acetate, teriflunomide, sphingosine-1-phosphate receptor modulators, and natalizumab. The timing of vaccination played an important role in those treated with alemtuzumab. Humoral vaccine responses were significantly impaired by B cell depleting anti-CD20 monoclonal antibody therapies, particularly to a neoantigen. Data are lacking on vaccine responses in patients with multiple sclerosis taking cladribine and high-dose corticosteroids. Notably, the majority of these studies have focused on humoral responses, with few examining cellular immune responses to vaccination.
Prior investigations into the effects of individual disease-modifying therapies on immune responses to existing vaccines can serve as a guide to expected responses to a SARS-CoV-2 vaccine. Responses to any vaccination depend on the vaccine type, the type of response (recall versus response to a novel antigen), and the impact of the individual disease-modifying therapy on humoral and cellular immunity in response to that vaccine type. When considering a given therapy, clinicians should weigh its efficacy against MS for the individual patient versus potential impact on responses to vaccinations that may be needed in the future.
长期免疫记忆的发展依赖于体液和细胞免疫反应。疫苗接种旨在刺激针对病原体的这些反应。多项研究评估了多发性硬化症的疾病修正疗法对疫苗免疫反应的影响。这些研究的结果对需要接种疫苗且正在使用疾病修正疗法的多发性硬化症患者具有重要意义。
2020 年 5 月，使用 PubMed 和其他引擎进行了搜索，以收集评估各种疾病修正疗法对疫苗接种免疫反应影响的研究。
几项研究表明，接受多种疫苗类型治疗的人β干扰素治疗保留了免疫反应。有限的数据表明，二甲基富马酸治疗也能保留疫苗反应。在接受醋酸格拉替雷、特立氟胺、鞘氨醇-1-磷酸受体调节剂和那他珠单抗治疗的患者中，疫苗反应的程度不同。在接受阿仑单抗治疗的患者中，疫苗接种的时间起着重要作用。B 细胞耗竭抗 CD20 单克隆抗体治疗，特别是针对新抗原，显著损害了体液疫苗反应。关于多发性硬化症患者服用克拉屈滨和大剂量皮质类固醇的疫苗反应的数据缺乏。值得注意的是，这些研究大多数都集中在体液反应上，很少有研究检查疫苗接种的细胞免疫反应。
先前对个体疾病修正疗法对现有疫苗免疫反应的影响的研究可以作为对 SARS-CoV-2 疫苗预期反应的指南。任何疫苗接种的反应都取决于疫苗类型、反应类型（回忆反应与对新抗原的反应）以及个体疾病修正疗法对该疫苗类型的体液和细胞免疫的影响。在考虑特定疗法时，临床医生应权衡其对个体患者的 MS 疗效与对未来可能需要的疫苗接种反应的潜在影响。
