Abstract Details

Title Adaptive B-cell and T-cell responses to SARS-CoV-2 vaccination in patients with Multiple Sclerosis on disease modifying immunotherapy

Topic Multiple Sclerosis

Presentation(s) S5 - COVID and MS Basic Science (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Objective To expand understanding of the human immunological response to SARS-CoV-2 vaccination in patients with Multiple Sclerosis (MS) treated with anti-CD20 monoclonal therapy and sphingosine-1-phosphate (S1P) modulators.

Background Immunomodulatory therapy prescribed for patients with MS has been associated with decreased or absent anti-SARS-CoV-2 immunoglobulin production following COVID-19 vaccination. We investigate broader adaptive immune responses to SARS-CoV-2 vaccination measuring IgG immunoglobulin production and T-cell reactivity in a small cohort.

Design/Methods We used the Stanford Research Repository database to identify 55 MS patients by ICD10 code who were tested for B-cell and T-cell responses via SARS-CoV-2-IgG and SARS-CoV-2 Interferon Gamma Release Assay (IGRA), respectively. 96% (53/55) of patients were fully vaccinated (98% mRNA/2% Janssen). A Chi-square test compared differences in vaccine response between 3 different disease modifying treatment (DMT) groups: anti-CD20 therapy (n=24), S1P modulators (n=11), and off DMT/other MS therapies (n=20).

Results

In patients on anti-CD20 therapy, 71% (17/24) were positive for SARS-CoV-2 IGRA but negative for SARS-CoV-2 IgG, among which 65% (11/17) had low CD-19 levels (0-64 cells/uL, normal 100-500 cells/uL) with normal absolute lymphocyte count (ALC). Among patients who delayed vaccination by 4-6 months following anti-CD20 therapy, 13% (3/24) expressed SARS-CoV-2-IgG.

82% (9/11) of patients on S1P modulators showed absent SARS-CoV-2-IgG and SARS-CoV-2 IGRA responses, in association with low ALC (range 210-600 cells/uL, normal 1000-3000 cells/uL).

95% (19/20) of patients off DMT/on other MS therapies showed positive SARS-CoV-2-IgG and SARS-CoV-2 IRGA responses.

All vaccinated patients were assessed between 4 weeks and 6 months post-vaccination. These differential responses between treatment groups were significant (p<0.05).

Conclusions We demonstrate that among MS patients treated with anti-CD20 therapy, T-cell response was largely preserved despite greatly reduced B-cell response to SARS-CoV-2 vaccination. MS patients on S1P modulators demonstrated absence of both B-cell and T-cell response. The clinical correlation of this is to be determined.

Authors/Disclosures
Anna J. Tomczak, MSc (Stanford) PRESENTER	Miss Tomczak has nothing to disclose.
Julia Sumera (Stanford Neurology)	Miss Sumera has nothing to disclose.
Yamuna Joseph (Stanford University)	No disclosure on file
Danwei Wu, MD (Stanford University)	Dr. Wu has nothing to disclose.
Jamie C. McDonald, MD (Stanford University)	Dr. McDonald has nothing to disclose.
Neda Sattarnezhad Oskouei, MD (Stanford Univesrity)	Dr. Sattarnezhad Oskouei has received research support from National Institutes of Health (NIH). Dr. Sattarnezhad Oskouei has received research support from National Institute of Allergy and Infectious Diseases (NIAID).
Lucas Kipp, MD	The institution of Dr. Kipp has received research support from Genentech.
Christopher Lock, MD, MBBS, PhD (Stanford University)	Dr. Lock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Lock has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Lock has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Turning Point Litigation. Dr. Lock has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Goodell, DeVries, Leech & Dann, LLP. Dr. Lock has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for McQuaide Blasko Attorneys at Law. Dr. Lock has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for BENNETT BIGELOW & LEEDOM P.S. .
May Han, MD (Stanford University)	Dr. Han has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Han has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arena Pharmaceuticals.
Jeffrey E. Dunn, MD, FAAN (Stanford University Medical Center)	Dr. Dunn has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Dunn has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genzyme. The institution of Dr. Dunn has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Progentec Diagnostics. Dr. Dunn has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna Therapeutics. Dr. Dunn has received intellectual property interests from a discovery or technology relating to health care.

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