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Patients with NMOSD and MS can risk relapse after COVID-19 vaccination, but how significant is this risk compared to that of infection?

Among patients with immune-mediated diseases, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), COVID-19 vaccination and infection may result in increased activity. These cases of disease relapse tend to occur soon after vaccination or infection, and in some cases may be severe enough to warrant additional safety measures, or the delay or deferral of vaccination. This study, published in Multiple Sclerosis and Related Disorders, analyzed the short-term risk of relapse related to both vaccination and infection in patients with these demyelinating disorders, including an assessment of disease exacerbation factors.

This retrospective, observational study used data collected from March 2020 to October 2021. Patients with at least one clinical relapse in the 90 days following vaccination or infection were compared to the same 90-day interval the year prior. The risk of relapse was evaluated using a comparison between groups with and without relapses after infection or vaccination. A total of 1661 vaccinated patients with MS and 495 unvaccinated patients with MS who experienced COVID-19 were identified, and their results mirrored the small cohort of patients with NMOSD that were used for the study as well. 

The authors found a mild increase in the proportion of patients with at least one clinical relapse after vaccination and a similar rise among patients who were infected with COVID-19. Relapse after vaccination was associated with lower age. The authors note that although there is a mild risk of relapse after receiving the COVID-19 vaccine in patients with these demyelinating conditions, these risks need to be considered against the risk of COVID-19 infection, which causes similar rises in relapse rate while increasing the risk of morbidity and mortality.

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Stastna, D., Menkyova, I., Drahota, J., Hrnciarova, T., Kubala Havrdova, E., Vachova, M., Andelova, M., Kleinova, P., Kovarova, I., Krasulova, E., Preiningerova, J. L., Novakova, I., Novotna, K., Novotna, M., Nytrova, P., Pavlickova, J., Srpova, B., Storey, K., Ticha, V., . . . Horakova, D. (2022). To be or not to be vaccinated: The risk of MS or NMOSD relapse after COVID-19 vaccination and infection. Mult Scler Relat Disord, 65, 104014. https://doi.org/10.1016/j.msard.2022.104014