SARS-CoV-2 mRNA Vaccination in People with Multiple Sclerosis Treated with Fingolimod: Protective Humoral Immune Responses May Develop after the Preferred Third Shot

Lutz Achtnichts; Arkady Ovchinnikov; Barbara Jakopp; Michael Oberle; Krassen Nedeltchev; Christoph Andreas Fux; Johann Sellner; Oliver Findling

doi:10.3390/vaccines10020341

SARS-CoV-2 mRNA Vaccination in People with Multiple Sclerosis Treated with Fingolimod: Protective Humoral Immune Responses May Develop after the Preferred Third Shot

Vaccines (Basel). 2022 Feb 21;10(2):341. doi: 10.3390/vaccines10020341.

Authors

Lutz Achtnichts¹, Arkady Ovchinnikov¹, Barbara Jakopp², Michael Oberle³, Krassen Nedeltchev^{1

4}, Christoph Andreas Fux², Johann Sellner⁵, Oliver Findling^{1

6}

Affiliations

¹ Department of Neurology, Aarau Cantonal Hospital, 5000 Aarau, Switzerland.
² Department of Infectious Diseases and Hospital Infection Prevention, Aarau Cantonal Hospital, 5000 Aarau, Switzerland.
³ Institute for Laboratory Medicine, Aarau Cantonal Hospital, 5000 Aarau, Switzerland.
⁴ Department of Neurology, University of Bern, 3012 Bern, Switzerland.
⁵ Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, 2130 Mistelbach, Austria.
⁶ MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Head, Spine and Neuromedicine, Clinical Research and Biomedicine and Biomedical Engineering, University Hospital and University of Basel, 4031 Basel, Switzerland.

Abstract

Evidence suggests limited development of protective IgG responses to mRNA-based vaccines in sphingosine-1-phosphate receptor (S1PR)-modulator treated individuals with multiple sclerosis (MS). We studied the extent of the humoral immune response after the preferred third mRNA SARS-CoV-2 vaccine in S1PR-modulator treated people with MS (pwMS) and insufficient IgG responses after the standard immunization scheme. Eight pwMS that were treated with fingolimod received a third homologous SARS-CoV-2 mRNA vaccine dose, either the Moderna's mRNA-1273 or Pfizer-BioNTech's BNT162b2 vaccine. We quantified the serum levels of IgG antibodies against the receptor-binding domain of SARS-CoV-2 four weeks later. An antibody titer of 100 AU/mL or more was considered protective. After the third vaccination, we found clinically relevant IgG titers in four out of eight individuals (50%). We conclude that the humoral immune response may reach protective levels after the third preferred dose of the homologous SARS-CoV-2 mRNA vaccine. Vaccine shots in S1PR-modulator treated pwMS ahead of schedule may be a strategy to overcome insufficient humoral immune responses following the standard vaccination scheme.

Keywords: COVID-19; S1PR-modulator; SARS-CoV-2; fingolimod; humoral immune response; vaccination.