Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Mult Scler. 2021 Dec;27(14):2209-2218. doi: 10.1177/13524585211049391. Epub 2021 Oct 1.
Knowledge on immunity after SARS-CoV-2 infection in patients with multiple sclerosis (pwMS) and the impact of disease-modifying treatment (DMT) is limited.
To evaluate degree, duration and potential predictors of specific humoral immune response in pwMS with prior COVID-19.
Anti-SARS-CoV-2 antibody testing was performed in pwMS with PCR-confirmed diagnosis of symptomatic COVID-19 from a nation-wide registry. Predictors of seropositivity were identified by multivariate regression models.
In 125 pwMS (mean age = 42.4 years (SD = 12.3 years), 70% female), anti-SARS-CoV-2 antibodies were detected in 76.0% after a median of 5.2 months from positive PCR. Seropositivity rate was significantly lower in patients on IS-DMT (61.4%, = 0.001) than without DMT or immunomodulatory DMT (80.6%; 86.0%, respectively). In multivariate analysis, IS-DMT was associated with reduced probability of seropositivity (odds ratio (OR): 0.51; 95% confidence interval (95% CI): 0.17-0.82; < 0.001). Predefined subgroup analyses showed marked reduction of seropositivity in pwMS on rituximab/ocrelizumab (OR 0.15; 95% CI: 0.05-0.56; < 0.001). Rate of seropositivity did not change significantly over 6 months.
Humoral immunity is stable after SARS-CoV-2 infection in MS, but is reduced by immunosuppressive DMT, particularly anti-CD20 monoclonal antibodies. This provides important evidence for advising pwMS as well as for planning and prioritizing vaccination.
关于多发性硬化症（pwMS）患者感染 SARS-CoV-2 后的免疫知识以及疾病修正治疗（DMT）的影响有限。
评估先前患有 COVID-19 的 pwMS 中特异性体液免疫反应的程度、持续时间和潜在预测因素。
从全国性登记处中，对 PCR 确诊为有症状 COVID-19 的 pwMS 进行抗 SARS-CoV-2 抗体检测。通过多变量回归模型确定血清阳性的预测因素。
在 125 例 pwMS（平均年龄=42.4±12.3 岁，70%为女性）中，中位时间为阳性 PCR 后 5.2 个月后，有 76.0%检测到抗 SARS-CoV-2 抗体。在接受免疫抑制性 DMT（IS-DMT）的患者中，血清阳性率明显低于未接受 DMT 或免疫调节性 DMT 的患者（61.4%，=0.001；80.6%，86.0%）。多变量分析显示，IS-DMT 与血清阳性率降低相关（优势比（OR）：0.51；95%置信区间（95%CI）：0.17-0.82； < 0.001）。预定义的亚组分析显示，在接受利妥昔单抗/奥瑞珠单抗的 pwMS 中，血清阳性率明显降低（OR 0.15；95%CI：0.05-0.56； < 0.001）。在 6 个月内，血清阳性率没有显著变化。
在 MS 患者中，SARS-CoV-2 感染后体液免疫稳定，但免疫抑制性 DMT 会降低，特别是抗 CD20 单克隆抗体。这为为 pwMS 提供了重要的证据，也为疫苗接种计划和优先顺序提供了依据。
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