Key clinical point: Short-term fingolimod discontinuation until the absolute lymphocyte count increases to >1,000 cells/mm 3 may improve the SARS-CoV-2 mRNA vaccine-specific humoral response in patients with multiple sclerosis (MS) but not the adaptive cellular response.
Major finding: Overall, 80% vs. 20% of patients in the fingolimod-discontinuation vs. fingolimod-continuation group developed a positive humoral response against SARS-CoV-2 1 month after the third vaccine dose, with a significantly higher median immunoglobulin (Ig) G titer in the fingolimod-discontinuation vs. fingolimod-continuation group (202.3 vs. 26.4 binding antibody units/mL; P = .022).
Study details: This was a prospective monocentric 3-month randomized clinical trial involving 20 patients with relapsing-remitting MS on fingolimod therapy who received the third dose of BNT162b2 vaccine after failing to develop a humoral IgG immune response to the previous 2 doses and were randomly assigned to the fingolimod-continuation or fingolimod-discontinuation group.
Disclosures: This study was supported by Sheba Multiple Sclerosis Research Grant. The authors declared no conflicts of interest.
Source: Achiron A et al. Immune response to the third COVID-19 vaccine dose is related to lymphocyte count in multiple sclerosis patients treated with fingolimod. J Neurol. 2022 (Mar 2). Doi: 10.1007/s00415-022-11030-0