Multiple sclerosis: those patients for whom the anti-covid vaccine does not work

VACCINATION – On the eve of World Multiple Sclerosis Day, specialists are worried: some treatments for this disease seem to cancel the protection of vaccines against Covid-19. Worse, the risk of making serious forms would be accentuated.

Their code name: anti-CD20. “Around 20% of patients with multiple sclerosis (MS) take this type of treatment, either at the onset of their disease or because the others have not worked”, explains to AFP the neurologist Jean Pelletier, of the Arsep Foundation (Research aid on multiple sclerosis). But according to him, patients treated with these drugs, in this case rituximab and ocrelizumab, “are both more exposed to severe forms of Covid and may respond less well to vaccination “.

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Administered “in the form of infusions every six months”, they are “extremely effective in the basic treatment of multiple sclerosis”, according to Prof. Pelletier. But from the point of view of the Covid, it is on the other hand the double penalty. On the one hand, the increased risk of having serious forms of Covid has been highlighted in recent months by several studies, French, Italian and American, according to the neurologist.

On the other hand, more recently, fears have arisen concerning vaccination. “We see people treated with these anti-CD20 who do not produce antibodies after vaccination against Covid”, explains Professor Pelletier, with therefore the risk of “non-protection”. This is all the more worrying as the effect of these treatments seems “probably much longer” than the six-month interval they take.

Other autoimmune diseases involved

At this stage, these observations are primarily based on “special cases”, but studies will reveal more.

This is particularly the case of a French study headed by Inserm and called COV-POPART. It “aims to assess the effect of vaccination against Covid” in patients treated for several diseases (cancer, kidney disease, diabetes, MS, etc.), depending on the treatments they are taking.

For multiple sclerosis, 600 patients should participate, and “we will be able to have a first answer in six months”, hopes Professor Pelletier, according to whom this could make it necessary to adapt the vaccination strategy in the people concerned. “This class of anti-CD20 is not specific to multiple sclerosis, but is used in many other autoimmune diseases such as rheumatoid arthritis, psoriasis. So this is a question that goes beyond multiple sclerosis. “, he emphasizes.

The effects that anti-CD20s seem to cause from the point of view of Covid could be explained by the fact that these drugs act on B lymphocytes, “cells that make antibodies”, according to the specialist. On the other hand, there is no similar signal concerning other DMARDs, such as interferons, which could even have an effect. “a little protective”, says Professor Pelletier.

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Multiple sclerosis is an autoimmune disease of the central nervous system (brain and spinal cord). It causes a disruption of the immune system, which attacks myelin, the protective sheath of nerve fibers. Most often, it causes inflammatory outbreaks interrupted by phases of calm. The high-dose corticosteroid treatment used to counter only these relapses (as opposed to disease-modifying treatments) could also be a risk factor for severe forms of Covid, according to Professor Pelletier. It is estimated that more than 2.8 million people are affected by this disease worldwide (110,000 in France).

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