To be or not to be vaccinated: The risk of MS or NMOSD relapse after COVID-19 vaccination and infection

Dominika Stastna; Ingrid Menkyova; Jiri Drahota; Tereza Hrnciarova; Eva Kubala Havrdova; Marta Vachova; Michaela Andelova; Pavlina Kleinova; Ivana Kovarova; Eva Krasulova; Jana Lizrova Preiningerova; Iveta Novakova; Klara Novotna; Martina Novotna; Petra Nytrova; Jana Pavlickova; Barbora Srpova; Katerina Storey; Veronika Ticha; Michaela Tyblova; Tomas Uher; Karolina Vodehnalova; Dana Horakova

doi:10.1016/j.msard.2022.104014

To be or not to be vaccinated: The risk of MS or NMOSD relapse after COVID-19 vaccination and infection

Mult Scler Relat Disord. 2022 Sep:65:104014. doi: 10.1016/j.msard.2022.104014. Epub 2022 Jul 2.

Authors

Dominika Stastna¹, Ingrid Menkyova², Jiri Drahota³, Tereza Hrnciarova¹, Eva Kubala Havrdova¹, Marta Vachova⁴, Michaela Andelova¹, Pavlina Kleinova¹, Ivana Kovarova¹, Eva Krasulova¹, Jana Lizrova Preiningerova¹, Iveta Novakova¹, Klara Novotna¹, Martina Novotna¹, Petra Nytrova¹, Jana Pavlickova¹, Barbora Srpova¹, Katerina Storey¹, Veronika Ticha¹, Michaela Tyblova¹, Tomas Uher¹, Karolina Vodehnalova¹, Dana Horakova⁵

Affiliations

¹ Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia.
² Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia; 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
³ Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia; Endowment Fund IMPULS, Prague, Czechia.
⁴ Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia; Department of Neurology, KZ a.s., Hospital Teplice, Teplice, Czechia.
⁵ Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia. Electronic address: dana.horakova@vfn.cz.

Abstract

Background: COVID-19 vaccination and infection are speculated to increase the activity of immune-mediated diseases, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). The aim of this study was to evaluate a short-term risk of relapse after COVID-19 vaccination and COVID-19 infection in patients with these demyelinating disorders of the central nervous system and to determine disease exacerbation risk factors.

Methods: Data in this retrospective, observational cohort study was collected via the Czech nationwide registry ReMuS from March 1, 2020, to October 30, 2021. We compared the proportion of patients with at least one clinical relapse in the 90 days following vaccination or infection to the 90-day intervals during the year before. For the evaluation of the risk factors of relapse, a comparison between groups with and without relapses after COVID-19 vaccination or infection was made.

Results: We identified 1661 vaccinated (90.11% BNT162b2) patients with MS without a history of COVID-19 and 495 unvaccinated patients with MS who experienced COVID-19. A mild increase in the proportion of patients with at least one clinical relapse (-360 to -270 days: 4.46%; -270 to -180: 4.27%; -180 to -90: 3.85%; -90 to 0: 3.79% vs. 0 to +90 days: 5.30%) after vaccination in patients with MS was observed, as well as a rise in the proportion of patients with at least one clinical relapse after COVID-19. Lower age was associated with MS relapse after vaccination or infection. Although there were only 17 vaccinated and eight post-COVID-19 patients with NMOSD, the results were broadly consistent with those of patients with MS.

Conclusion: There is a mild increase in the relapse incidence after the COVID-19 vaccination. The risks, however, need to be balanced against the risks of COVID-19 itself, also leading to the rise in relapse rate and particularly to morbidity and mortality.

Keywords: Acute relapse; COVID-19; Multiple sclerosis; Neuromyelitis optica; Vaccination.

Publication types

Observational Study

MeSH terms

BNT162 Vaccine
COVID-19 Vaccines* / adverse effects
COVID-19* / prevention & control
Czech Republic
Humans
Multiple Sclerosis* / complications
Neuromyelitis Optica* / complications
Recurrence
Retrospective Studies
Vaccination / adverse effects

Substances

COVID-19 Vaccines
BNT162 Vaccine