• Zoé L E van Kempen, Eileen W Stalman, Maurice Steenhuis, Laura Y L Kummer, Koos P J van Dam, Maarten F Wilbrink, Anja Ten Brinke, van HamS MariekeSMImmunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.Swammerdam Insitute for Life Sciences, Amsterdam UMC, Amsterdam, The Netherlands., Taco Kuijpers, Theo Rispens, Filip Eftimov, Luuk Wieske, Joep Killestein, and T2B! immunity against SARS-CoV-2 study group.
• Neurology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands Z.vankempen@amsterdamumc.nl.
• J. Neurol. Neurosurg. Psychiatr. 2023 Apr 1; 94 (4): 280283280-283.

BackgroundIt is unclear which patients with multiple sclerosis (MS) are most susceptible for omicron breakthrough infections.MethodsWe assessed omicron breakthrough infections in vaccinated patients with MS with and without disease-modifying therapies enrolled in an ongoing large prospective study. We longitudinally studied humoral responses after primary and booster vaccinations and breakthrough infections.ResultsOmicron breakthrough infections were reported in 110/312 (36%) patients with MS, and in 105/110 (96%) infections were mild. Omicron breakthrough infections occurred more frequently in patients treated with anti-CD20 therapies and sphingosine-1 phosphate receptor (S1PR) modulators, patients with impaired humoral responses after primary immunisation (regardless of treatment) and patients without prior SARS-CoV-2 infections. After infection, antibody titres increased in patients on S1PR modulator treatment while anti-CD20 treated patients did not show an increase.ConclusionsSARS-COV-2 omicron breakthrough infections are more prevalent in patients with MS on anti-CD20 therapies and S1PR modulators compared with other patients with MS, which correlated with decreased humoral responses after vaccination. Humoral responses after infection were higher in S1PR modulator-treated patients in comparison to patients on anti-CD20 therapies, suggesting that immunological protection from contracting infection or repeated exposures may differ between these therapies.© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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