SARS-CoV-2 Antibodies in Adult Patients With Multiple Sclerosis in the Amsterdam MS Cohort
JAMA Neurol. April 30, 2021. doi:10.1001/jamaneurol.2021.1364
Zoé L. E. van Kempen, PhD1; Eva M. M. Strijbis, PhD1; Marissa M. C. T. Al, BSc1; et alMaurice Steenhuis, MSc2; Bernard M. J. Uitdehaag, PhD1; Theo Rispens, PhD2; Joep Killestein, PhD1
- COVID death rate was 3X lower in those with Multiple Sclerosis (85 pcnt were taking Vitamin D) - Jan 2022
- People with Multiple Sclerosis taking at least 5,000 IU of Vitamin D felt much better – April 2021
- UK people with Multiple Sclerosis are 3X more likely to take Vitamin D - Oct 2020
- Rate of vitamin D supplementation by Blacks increases 16X after getting Multiple Sclerosis – Feb 2018
- VitaminDwiki suspects that >1/2 of MSers around the world now supplement with Vitamin D
- Multiple Sclerosis relapses cut in half by 100,000 IU of Vitamin D every 2 weeks– RCT 2019
- Successful high dose vitamin D (Coimbra Protocol) should be evaluated – June 2019
- High-dose Vitamin D protocol is in use by >20,000 patients via >200 doctors around the world
- People with Multiple Sclerosis taking at least 5,000 IU of Vitamin D felt much better – April 2021
COVID-19 treated by Vitamin D - studies, reports, videos
- As of March 31, 2024, the VitaminDWiki COVID page had: trial results, meta-analyses and reviews, Mortality studies see related: Governments, HealthProblems, Hospitals, Dark Skins, All 26 COVID risk factors are associated with low Vit D, Fight COVID-19 with 50K Vit D weekly Vaccines Take lots of Vitamin D at first signs of COVID 166 COVID Clinical Trials using Vitamin D (Aug 2023) Prevent a COVID death: 9 dollars of Vitamin D or 900,000 dollars of vaccine - Aug 2023
5 most-recently changed Virus entries
26 studies cited this study as of June 2022
Various cohorts of patients with multiple sclerosis (MS) and COVID-19 have been described. So far, limited information is available regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in patients with MS. The objective of this study was to test for SARS-CoV-2 antibodies in a large MS cohort to evaluate asymptomatic infections and immunological responses to COVID-19.
Methods
This is a prospective cohort study conducted at the MS Center Amsterdam in Amsterdam, the Netherlands. On July 31, 2020, all adult patients with a current diagnosis of MS who had visited the MS Center Amsterdam in the past 2 years were invited to participate. The database was closed on December 18, 2020. The study was approved by the Medical Ethical Committee of the VU University Medical Center, and all patients provided written informed consent. The STROBE reporting guideline was followed.
Blood samples were drawn for SARS-CoV-2 antibody measurements with a total antibody assay with 98.1% sensitivity and 99.5% specificity.1 Signals were quantified as normalized optical density (nOD) units, ranging from low (0.1-1.0 nOD) to high (>1.0 nOD). In the week following blood sampling, patients filled in digital questionnaires regarding their characteristics, current MS complaints, and COVID-19 symptoms. Other MS-specific data were retrieved from the medical files. Groups were compared with the Mann-Whitney U test (for continuous data) or the Pearson χ2 test (categorical data). The level of significance was set at .05, and SPSS version 26.0 (IBM) was used for data analysis.
Results
A total of 1778 patients were contacted, and 546 patients were included (mean [SD] age, 46.9 [12.1] years; 388 women [71.1%]). Additional baseline characteristics are described in the Table. In 64 patients (11.7%), SARS-CoV-2 antibodies were detected. Thirty-five patients experienced COVID-19, as established by polymerase chain reaction (PCR) testing (Figure, A). Of the patients positive by PCR, 4 (11%) tested negative for SARS-CoV-2 antibodies.
Nine patients who were antibody positive (14%) did not experience any symptoms suggestive of COVID-19. The most frequently reported symptom in those positive for SARS-CoV-2 antibodies was a loss of taste and/or smell (30 of 64 patients [47%]), while only 14 of 482 patients (2.9%) without SARS-CoV-2 antibodies reported these symptoms. To our knowledge, there were no COVID-19 fatalities in this MS population.
Of all 546 patients, 405 (74.2%) were receiving disease-modifying therapy. In these, SARS-CoV-2 antibodies were less prevalent in patients using injectable drugs (interferon β and glatiramer acetate) than patients with other treatments (3 of 69 [4%] vs 44 of 336 [13.1%]; P = .04).
The median SARS-CoV-2 antibody response in patients treated with ocrelizumab was lower in comparison with other patients (0.2 [interquartile range, 0.1-0.4] nOD vs 2.5 [interquartile range, 0.6-2.5] nOD; P < .001; Figure, B ). All patients taking ocrelizumab were B-cell depleted, as measured at a median (range) of 2.5 (0-41) days before the antibody response was measured. None of these patients experienced hypogammaglobulinemia at that time.
Discussion
In this study, we found a lower SARS-CoV-2 antibody response in patients with MS who were depleted of B cells. Case reports2-4 have described patients with MS and neuromyelitis optica treated with anti-CD20 therapies who did not develop detectable SARS-CoV-2 antibodies after PCR-confirmed COVID-19. Furthermore, in a retrospective cohort,5 SARS-CoV-2 antibodies were less prevalent in patients with MS and suspected COVID-19 who were treated with ocrelizumab.
This cohort study showed that 14% of patients with MS and COVID-19 were asymptomatic for COVID-19, which is comparable with a reported 17% in the general population.6 Because patients may have been more willing to participate in this study after experiencing symptoms fitting COVID-19, the percentage of patients who were asymptomatic might be an underrepresentation.
A limitation of our study is the relatively low percentage of patients who were SARS-CoV-2 positive. Still, we were able to show a lower antibody response in patients depleted of B cells.
Conclusions
In conclusion, our data imply that B-cell depletion could influence SARS-CoV-2 antibody production in patients with MS. This holds important consequences for humoral immunity after COVID-19 infection and possibly vaccination.