Immune Response and Safety of SARS-CoV-2 mRNA-1273 Vaccine in Patients With Myasthenia Gravis
Reyes-Leiva, David (Institut d'Investigació Biomèdica Sant Pau)
López-Contreras, Joaquín (Institut d'Investigació Biomèdica Sant Pau)
Moga, Esther (Institut d'Investigació Biomèdica Sant Pau)
Pla-Juncà, Francesc (Institut d'Investigació Biomèdica Sant Pau)
Lynton-Pons, Elionor (Institut d'Investigació Biomèdica Sant Pau)
Rojas-Garcia, Ricard (Institut d'Investigació Biomèdica Sant Pau)
Turon-Sans, Janina (Institut d'Investigació Biomèdica Sant Pau)
Querol, Luis (Institut d'Investigació Biomèdica Sant Pau)
Olive, Montse (Institut d'Investigació Biomèdica Sant Pau)
Álvarez-Velasco, Rodrigo (Centro de Investigación Biomédica en Red de Enfermedades Raras)
Caballero-Ávila, Marta (Institut d'Investigació Biomèdica Sant Pau)
Carbayo Viejo, Álvaro (Institut d'Investigació Biomèdica Sant Pau)
Vesperinas-Castro, Ana (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Domingo, Pere (Institut d'Investigació Biomèdica Sant Pau)
Illa, Ignacio (Institut d'Investigació Biomèdica Sant Pau)
Gallardo, Eduard (Institut d'Investigació Biomèdica Sant Pau)
Cortés-Vicente, Elena (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Evidence regarding the safety and efficacy of messenger RNA (mRNA) vaccines in patients with myasthenia gravis (MG) after immunosuppressive therapies is scarce. Our aim is to determine whether the mRNA-1273 vaccine is safe and able to induce humoral and cellular responses in patients with MG. We performed an observational, longitudinal, prospective study including 100 patients with MG of a referral center for MG in our country, conducted from April 2021 to November 2021 during the vaccination campaign. The mRNA-1273 vaccine was scheduled for all participants. Blood samples were collected before vaccination and 3 months after a second dose. Clinical changes in MG were measured using the MG activities of daily life score at baseline and 1 week after the first and second doses. A surveillance of all symptoms of coronavirus disease 2019 (COVID-19) was conducted throughout the study. Humoral and cellular immune responses after vaccination were assessed using a spike-antibody ELISA and interferon gamma release assay in plasma. The primary outcomes were clinically significant changes in MG symptoms after vaccination, adverse events (AEs), and seroconversion and T-cell immune response rates. Ninety-nine patients completed the full vaccination schedule, and 98 had 2 blood samples taken. A statistically significant worsening of symptoms was identified after the first and second doses of the mRNA-1273 vaccine, but this was not clinically relevant. Mild AEs occurred in 14 patients after the first dose and in 21 patients after the second dose. Eighty-seven patients developed a humoral response and 72 patients showed a T-cell response after vaccination. A combined therapy with prednisone and other immunosuppressive drugs correlated with a lower seroconversion ratio (OR = 5. 97, 95% CI 1. 46-24. 09, p = 0. 015) and a lower T-cell response ratio (OR = 2. 83, 95% CI 1. 13-7. 13, p = 0. 024). Our findings indicate that the mRNA vaccination against COVID-19 is safe in patients with MG and show no negative impact on the disease course. Patients achieved high humoral and cellular immune response levels. This study provides Class IV evidence that patients with MG receiving the mRNA-1273 vaccine did not show clinical worsening after vaccination and that most of the patients achieved high cellular or immune response levels.
Grants:	Instituto de Salud Carlos III PI19/01774
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	Neurology® neuroimmunology & neuroinflammation, Vol. 9 Núm. 4 (20 2022) , p. E200002, ISSN 2332-7812

DOI: 10.1212/NXI.0000000000200002
PMID: 35728947

10 p, 393.7 KB

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