Abstract Details

Title Impact of Multiple Sclerosis Disease-Modifying Therapies on Effectiveness of SARS-Cov-2 Vaccines: A Longitudinal Total Population Study of National Health Service (NHS) England

Topic Multiple Sclerosis

Presentation(s) S5 - COVID and MS Basic Science (4:54 PM-5:06 PM)

Poster/Presentation
Number 008

Background Real-world data in the GP show that SARS-CoV-2 vaccines are effective in preventing infections, but it is still unclear whether vaccination offers the same level of protection for pwMS taking immunomodulatory DMTs.

Objective To compare the risk of SARS-CoV-2 infection before and after mass vaccination among patients with multiple sclerosis (pwMS) taking different disease-modifying therapies (DMTs) compared to the general population (GP).

Design/Methods National Health Service (NHS) England and NHS Improvement (NHSE/I) hold prescribing data on all MS DMTs in England. Public Health England (PHE) collected data on all SARS-CoV-2 tests in England. Datasets of NHE/I and PHE were merged to estimate the monthly rates of SARS-CoV-2 infections in the entire population of pwMS taking DMTs in England. Publicly available data were used for the same analysis in the GP. The relative risk (RR) of infection in pwMS taking DMTs compared to the GP was calculated during two waves of the pandemic: before (November 2020-January 2021) and after (July-September 2021) mass vaccination.

Results All 42,402 pwMS taking DMTs in England were included. A total of 28,113 (66.3%) patients were tested for SARS-CoV-2 out of whom 4,104 (14.6%) tested positive. Pre-vaccination, the RR (95%CI) of infection was beta-interferon: 0.75(0.65-0.87), cladribine: 0.93(0.75-1.14), dimethyl fumarate: 1.15(1.05-1.25), fingolimod: 0.88(0.76-1.02), glatiramer acetate: 1.05(0.93-1.19), natalizumab: 1.08(0.96-1.21), ocrelizumab: 1.20(1.07-1.34), teriflunomide 0.79(0.63-0.99). Post-vaccination, it was beta-interferon: 0.73(0.63-0.85), cladribine: 1.21(1.02-1.45), dimethyl fumarate: 1.34(1.24-1.45), fingolimod: 1.63(1.47-1.82), glatiramer acetate: 0.85(0.74-0.98), natalizumab: 1.22(1.10-1.36), ocrelizumab: 2.18(2-2.36), teriflunomide: 1.04 (0.85-1.27).

Conclusions The risk of SARS-CoV-2 infection in patients taking ocrelizumab and fingolimod substantially increased compared to the general population following vaccination which agrees with the suppressed humoral immune response observed with these DMTs. The changes associated with other DMTs are less clear. Further analysis of data collected longitudinally over a longer period will reveal their impact on the effectiveness of SARS-CoV-2 vaccines.

Authors/Disclosures
Afagh Garjani, MD (Nottingham University Hospitals NHS Trust) PRESENTER	The institution of Dr. Garjani has received research support from UK MS Society. Dr. Garjani has received personal compensation in the range of $0-$499 for serving as a Speaker with MS Academy. Dr. Garjani has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Biogen.
Sameer Patel (AGEM CSU)	No disclosure on file
	No disclosure on file
	No disclosure on file
Waqar Rashid	Waqar Rashid has nothing to disclose.
Alasdair Coles, MD, PhD (University of Cambridge)	Dr. Coles has nothing to disclose.
Nikolaos Evangelou, PhD (Nottingham University, QMC campus)	Dr. Evangelou has received personal compensation in the range of $0-$499 for serving as a Consultant for Novartis . Dr. Evangelou has received personal compensation in the range of $0-$499 for serving as a Consultant for Novartis . The institution of Dr. Evangelou has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Roche. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck . Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen . Dr. Evangelou has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis . Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for biogen. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for UK crown prosecution service. Dr. Evangelou has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Novartis .