新型冠状病毒病疫苗在接受疾病修正治疗的多发性硬化症患者中的反应：一项荟萃分析。
Response of COVID-19 vaccination in multiple sclerosis patients following disease-modifying therapies: A meta-analysis.
机构信息
Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030, China.
Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai 200051, China.
出版信息
EBioMedicine. 2022 Jul;81:104102. doi: 10.1016/j.ebiom.2022.104102. Epub 2022 Jun 24.
BACKGROUND
COVID-19 vaccination is recommended for patients with multiple sclerosis (pwMS), while disease-modifying therapies (DMTs) may influence the efficacy of SARS-CoV-2 vaccines in this population. Thus, we conducted a meta-analysis to evaluate the impact of DMTs on immune response to COVID-19 vaccines in pwMS.
METHODS
Literature search from December 1, 2019 to March 31, 2022 was performed in PubMed, MedRxiv, Embase and Cochrane Library. The risk of impaired response to vaccination in pwMS receiving DMTs was estimated in odds ratios (ORs) using random-effects method.
FINDINGS
A total of 48 studies comprising 6860 pwMS were included. Overall, pwMS with anti-CD20 (OR=0.02, 95% CI: 0.01-0.03) and sphingosine-1-phosphate receptor modulator (S1PRM) (OR=0.03, 95% CI: 0.01-0.06) treatments had attenuated serologic response after full vaccination compared with those without DMTs. Additionally, pwMS vaccinated within six months since last anti-CD20 therapy were at significantly higher risk of blunted response compared with those receiving anti-CD20 therapy more than six months prior to vaccination (P = 0.001). We found no significant associations between other treatments (including IFN-β, GA, DMF, TERI, NTZ, CLAD, and ALE) and humoral response to SARS-CoV-2 vaccines in pwMS. As for T-cell response, no significant difference was found between pwMS on anti-CD20 and those without DMTs after vaccination, while S1PRM was marginally associated with impaired cellular response (P = 0.03).
INTERPRETATION
Our findings suggested that routine serological monitoring may be required for pwMS on anti-CD20 and S1PRMs after SARS-CoV-2 vaccination and highlighted the benefits of a booster dose. The effect of cellular response and optimal interval from last anti-CD20 treatment to vaccination should be further addressed.
FUNDING
This study was supported by Natural Science Foundation of Shanghai (21ZR1433000).
背景
COVID-19 疫苗已被推荐用于多发性硬化症（pwMS）患者，而疾病修正疗法（DMTs）可能会影响 SARS-CoV-2 疫苗在该人群中的效果。因此，我们进行了一项荟萃分析，以评估 DMTs 对 pwMS 对 COVID-19 疫苗免疫反应的影响。
方法
我们于 2019 年 12 月 1 日至 2022 年 3 月 31 日在 PubMed、MedRxiv、Embase 和 Cochrane Library 进行了文献检索。采用随机效应法估计 pwMS 接受 DMT 治疗后疫苗接种反应受损的风险比（ORs）。
发现
共有 48 项研究纳入了 6860 名 pwMS。总体而言，与未接受 DMTs 的 pwMS 相比，接受抗 CD20（OR=0.02，95%CI：0.01-0.03）和鞘氨醇-1-磷酸受体调节剂（S1PRM）（OR=0.03，95%CI：0.01-0.06）治疗的 pwMS 在完全接种疫苗后血清学反应减弱。此外，与在接受抗 CD20 治疗六个月前接种疫苗的 pwMS 相比，在接受抗 CD20 治疗后六个月内接种疫苗的 pwMS 发生反应减弱的风险显著更高（P=0.001）。我们未发现其他治疗方法（包括 IFN-β、GA、DMF、TERI、NTZ、CLAD 和 ALE）与 pwMS 对 SARS-CoV-2 疫苗的体液反应之间存在显著关联。至于 T 细胞反应，接种疫苗后接受抗 CD20 治疗的 pwMS 与未接受 DMTs 的 pwMS 之间未见显著差异，而 S1PRM 则与细胞反应受损有一定相关性（P=0.03）。
解释
我们的研究结果表明，在 SARS-CoV-2 疫苗接种后，pwMS 接受抗 CD20 和 S1PRM 治疗可能需要常规进行血清学监测，并强调了加强针的益处。还需要进一步研究细胞反应的影响以及最后一次接受抗 CD20 治疗与接种疫苗之间的最佳时间间隔。
资金
本研究由上海市自然科学基金（21ZR1433000）资助。
Zotero 插件