Observational studyEBioMedicine2021
Effect of SARS-CoV-2 mRNA vaccination in MS patients treated with disease modifying therapies.
Observational study in EBioMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 142 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
142 citing papers in PubMed, 6 syntheses or guidelines pooled it, 223 citations in OpenAlex.
- ECTRIMS/EAN consensus on vaccination in people with multiple sclerosis: Improving immunization strategies in the era of highly active immunotherapeutic drugs.Multiple sclerosis (Houndmills, Basingstoke, England) · 2023Pooled it
- A systematic and thematic analysis of the top 100 cited articles on mRNA vaccine indexed in Scopus database.Human vaccines & immunotherapeutics · 2022Pooled it
- Immune responses to SARS-CoV-2 vaccination in multiple sclerosis: a systematic review/meta-analysis.Annals of clinical and translational neurology · 2022Pooled it
- COVID-19 mRNA Vaccine in Patients With Lymphoid Malignancy or Anti-CD20 Antibody Therapy: A Systematic Review and Meta-Analysis.Clinical lymphoma, myeloma & leukemia · 2022Pooled it
- Pooled it
- Risk factors of severe COVID-19 in people with multiple sclerosis : A systematic review and meta-analysis.Revue neurologiquePooled it
- Efficacy and safety of four-year ofatumumab treatment in relapsing multiple sclerosis: The ALITHIOS open-label extension.Multiple sclerosis (Houndmills, Basingstoke, England) · 2023Trial
- Immune response to the third COVID-19 vaccine dose is related to lymphocyte count in multiple sclerosis patients treated with fingolimod.Journal of neurology · 2022Trial
- B- and T-Cell Responses After SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis Receiving Disease Modifying Therapies: Immunological Patterns and Clinical Implications.Frontiers in immunology · 2021Trial
- Optimizing the Use of Anti-CD20 Agents in Multiple Sclerosis and Other Autoimmune Central Nervous System Disorders: A Narrative Review.Neurology and therapy · 2026Review
- CD56Clinical & translational immunology · 2026Article
- Multiple sclerosis patients under treatment with interferon β1-a or ocrelizumab exhibit different T and B cell responses to SARS-CoV-2 vaccine.Frontiers in immunology · 2026Article
- Durable T cell immunity to COVID-19 vaccines in MS patients on B cell depletion therapy.NPJ vaccines · 2025Article
- Recall vaccination increases detectable B-cell reactivity in persons with multiple sclerosis treated with ocrelizumab.Journal of neurology · 2025Article
- Evaluation of the efficacy of the SARS-CoV-2 vaccine additional and booster doses in immunocompromised patients with multiple sclerosis: the COVACiMS study.Journal of neurology · 2025Article
- Extensive T-Cell Profiling Following SARS-CoV-2 mRNA Vaccination in Multiple Sclerosis Patients Treated with DMTs.Pathogens (Basel, Switzerland) · 2025Article
- Humoral and Cellular Immunity After Vaccination Against SARS-CoV-2 in Relapsing-Remitting Multiple Sclerosis Patients Treated with Interferon Beta and Dimethyl Fumarate.Biomedicines · 2025Article
- Cellular and humoral vaccination response under immunotherapies-German consensus on vaccination strategies in neurological autoimmune diseases.Therapeutic advances in neurological disorders · 2025Article
- Twenty years of natalizumab in multiple sclerosis: lessons learned and future outlook.Therapeutic advances in neurological disorders · 2025Review
- T cell activation markers CD38 and HLA-DR indicative of non-seroconversion in anti-CD20-treated patients with multiple sclerosis following SARS-CoV-2 mRNA vaccination.Journal of neurology, neurosurgery, and psychiatry · 2024Article
82 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
36 authors at 20 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn patients with Multiple Sclerosis (pwMS) disease-modifying therapies (DMTs) affects immune response to antigens. Therefore, post-vaccination serological assessments are needed to evaluate the effect of the vaccine on SARS-CoV-2 antibody response.
methodsWe designed a prospective multicenter cohort study enrolling pwMS who were scheduled for SARS-Cov-2 vaccination with mRNA vaccines (BNT162b2, Pfizer/BioNTech,Inc or mRNA-1273, Moderna Tx,Inc). A blood collection before the first vaccine dose and 4 weeks after the second dose was planned, with a centralized serological assessment (electrochemiluminescence immunoassay, ECLIA, Roche-Diagnostics). The log-transform of the antibody levels was analyzed by multivariable linear regression.
findings780 pwMS (76% BNT162b2 and 24% mRNA-1273) had pre- and 4-week post-vaccination blood assessments. 87 (11·2%) were untreated, 154 (19·7%) on ocrelizumab, 25 (3·2%) on rituximab, 85 (10·9%) on fingolimod, 25 (3·2%) on cladribine and 404 (51·7%) on other DMTs. 677 patients (86·8%) had detectable post-vaccination SARS-CoV-2 antibodies. At multivariable analysis, the antibody levels of patients on ocrelizumab (201-fold decrease (95%CI=128-317), p < 0·001), fingolimod (26-fold decrease (95%CI=16-42), p < 0·001) and rituximab (20-fold decrease (95%CI=10-43), p < 0·001) were significantly reduced as compared to untreated patients. Vaccination with mRNA-1273 resulted in a systematically 3·25-fold higher antibody level (95%CI=2·46-4·27) than with the BNT162b2 vaccine (p < 0·001). The antibody levels on anti-CD20 therapies correlated to the time since last infusion, and rituximab had longer intervals (mean=386 days) than ocrelizumab patients (mean=129 days).
interpretationIn pwMS, anti-CD20 treatment and fingolimod led to a reduced humoral response to mRNA-based SARS-CoV-2 vaccines. As mRNA-1273 elicits 3·25-higher antibody levels than BNT162b2, this vaccine may be preferentially considered for patients under anti-CD20 treatment or fingolimod. Combining our data with those on the cellular immune response to vaccines, and including clinical follow-up, will contribute to better define the most appropriate SARS-CoV-2 vaccine strategies in the context of DMTs and MS.
fundingFISM[2021/Special-Multi/001]; Italian Ministry of Health'Progetto Z844A 5 × 1000'.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.