Vaccination in patients with multiple sclerosis (MS) treated with immunosuppressive drugs is highly recommended. Regarding COVID-19 vaccination, no specific concern has been raised.
Objectives:
We aimed to evaluate if COVID-19 vaccination or infection increased the risk of disease activity, either radiological or clinical, with conversion to MS in a cohort of people with a radiologically isolated syndrome (RIS).
Methods:
This multicentric observational study analyzed patients in the RIS Consortium cohort during the pandemic between January 2020 and December 2022. We compared the occurrence of disease activity in patients according to their vaccination status. The same analysis was conducted by comparing patients’ history of COVID-19 infection.
Results:
No difference was found concerning clinical conversion to MS in the vaccinated versus unvaccinated group (6.7% vs 8.5%, p > 0.9). The rate of disease activity was not statistically different (13.6% and 7.4%, respectively, p = 0.54). The clinical conversion rate to MS was not significantly different in patients with a documented COVID-19 infection versus non-infected patients.
Conclusion:
Our study suggests that COVID-19 infection or immunization in RIS individuals does not increase the risk of disease activity. Our results support that COVID-19 vaccination can be safely proposed and repeated for these subjects.
OkudaDTMowryEMBeheshtianA, et al. Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome. Neurology2009; 72(9): 800–805.
2.
GranbergTMartolaJKristoffersen-WibergM, et al. Radiologically isolated syndrome—Incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review. Mult Scler J2013; 19(3): 271–280.
3.
ForslinYGranbergTJumahAA, et al. Incidence of radiologically isolated syndrome: A population-based study. Am J Neuroradiol2016; 37(6): 1017–1022.
4.
OkudaDTSivaAKantarciO, et al. Radiologically isolated syndrome: 5-year risk for an initial clinical event. PLoS ONE2014; 9(3): e90509.
5.
Lebrun-FrénayCKantarciOSivaA, et al. Radiologically isolated syndrome: 10-year risk estimate of a clinical event. Ann Neurol2020; 88(2): 407–417.
6.
OkudaDTKantarciOLebrun-FrénayC, et al. Dimethyl fumarate delays multiple sclerosis in radiologically isolated syndrome. Ann Neurol2023; 93(3): 604–614.
7.
Lebrun-FrénayCRollotFMondotL, et al. Risk factors and time to clinical symptoms of multiple sclerosis among patients with radiologically isolated syndrome. JAMA Netw Open2021; 4(10): e2128271.
8.
MuralidarSAmbiSVSekaranS, et al. The emergence of COVID-19 as a global pandemic: Understanding the epidemiology, immune response and potential therapeutic targets of SARS-CoV-2. Biochimie2020; 179: 85–100.
9.
Otero-RomeroSRodríguez-GarcíaJVilellaA, et al. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. Neurol Engl Ed2021; 36(1): 50–60.
10.
RivaABarcellaVBenattiSV, et al. Vaccinations in patients with multiple sclerosis: A Delphi consensus statement. Mult Scler J2021; 27(3): 347–359.
Lebrun-FrénayCVukusicS. Immunization and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Mult Scler Relat Disord2019; 31: 173–188.
14.
FarezMFCorrealeJArmstrongMJ, et al. Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology2019; 93(13): 584–594.
EtemadifarMSigariAASedaghatN, et al. Acute relapse and poor immunization following COVID-19 vaccination in a rituximab-treated multiple sclerosis patient. Hum Vaccines Immunother2021; 17(10): 3481–3483.
21.
IsmailIISalamaS. A systematic review of cases of CNS demyelination following COVID-19 vaccination. J Neuroimmunol2022; 362: 577765.
22.
NistriRBarbutiERinaldiV, et al. Case report: Multiple sclerosis relapses after vaccination against SARS-CoV2: A series of clinical cases. Front Neurol2021; 12: 765954.
23.
Quintanilla-BordásCGascón-GimenezFAlcaláC, et al. Case report: Exacerbation of relapses following mRNA COVID-19 vaccination in multiple sclerosis: A case series. Front Neurol2022; 13: 897275.
24.
AchironADolevMMenascuS, et al. COVID-19 vaccination in patients with multiple sclerosis: What we have learnt by February 2021. Mult Scler J2021; 27(6): 864–870.
25.
ChilimuriSMantriNGongatiS, et al. COVID-19 vaccine failure in a patient with multiple sclerosis on ocrelizumab. Vaccines2021; 9(3): 219.
26.
FragosoYDGomesSGonçalvesMVM, et al. New relapse of multiple sclerosis and neuromyelitis optica as a potential adverse event of AstraZeneca AZD1222 vaccination for COVID-19. Mult Scler Relat Disord2022; 57: 103321.
27.
ManiscalcoGTManzoVDi BattistaME, et al. Severe multiple sclerosis relapse after COVID-19 vaccination: A case report. Front Neurol2021; 12: 721502.
28.
StefanouMIPalaiodimouLTheodorouA, et al. Safety of COVID-19 vaccines in multiple sclerosis: A systematic review and meta-analysis. Mult Scler J2023; 29(4–5): 585–594.
FrancisAGElhaddKCameraV, et al. Acute inflammatory diseases of the central nervous system after SARS-CoV-2 vaccination. Neurol Neuroimmunol Neuroinflam2023; 10(1): e200063.
ZrzavyTKollaritschHRommerPS, et al. Vaccination in multiple sclerosis: Friend or foe?Front Immunol2019; 10: 1883.
33.
DeStefanoFVerstraetenTJacksonLA, et al. Vaccinations and risk of central nervous system demyelinating diseases in adults. Arch Neurol2003; 60(4): 504–509.
34.
ConfavreuxCSuissaSSaddierP, et al. Vaccinations and the risk of relapse in multiple sclerosis. N Engl J Med2001; 344(5): 319–326.
35.
Langer-GouldAQianLTartofSY, et al. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases. JAMA Neurol2014; 71(12): 1506–1513.
36.
PapeixCDonzeCLebrun-FrénayC, et al. Infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Rev Neurol2021; 177(8): 980–994.
37.
LakeCMBreenJJ. Sequence similarity between SARS-CoV-2 nucleocapsid and multiple sclerosis-associated proteins provides insight into viral neuropathogenesis following infection. Sci Rep2023; 13(1): 389.
