A large case-control study on vaccination as risk factor of multiple sclerosis
ECTRIMS Online Library. Gasperi C. 09/12/19; 279504; 224
Christiane Gasperi
Christiane Gasperi

Abstract: 224

Type: Scientific Session

Abstract Category: Pathology and pathogenesis of MS - Environmental factors

A. Hapfelmeier1, C. Gasperi2, E. Donnachie3, B. Hemmer2,4

1Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, 2Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, 3National Association of Statutory Health Insurance Physicians of Bavaria, 4Munich Cluster for Systems Neurology (SyNergy), Munich, Germany

Introduction: Various environmental risk factors for the development of Multiple Sclerosis (MS) have been suggested some of which could be confirmed in large studies. Vaccination has been discussed as a risk factor for the development of MS and for the occurrence of relapses. Different case reports and smaller studies on the relation to vaccination, however, showed conflicting results. The objective of the present case-control study was therefore to investigate the hypothesis that vaccination is a risk factor of MS in a systematic retrospective analysis of ambulatory claims data of 12,262 MS patients and 210,773 controls.
Methods: Using the ambulatory claims data of the Bavarian Association of Statutory Health Insurance Physicians (BASHIP) covering the years 2005 to 2017, logistic regression models were used to assess the relation between MS (n=12,262) and vaccinations in the five years before first diagnosis. Subjects newly diagnosed with Crohn´s disease (n=19,296), psoriasis (n=112,292) and subjects with no history of these autoimmune diseases (n=79,185) served as controls.
Results: The odds of MS was lower in subjects with a recorded vaccination (OR=0.870, p< 0.001 vs. subjects without autoimmune disease; OR=0.919, p< 0.001 vs. subjects with Crohn's disease; OR=0.973, p=0.177 vs. subjects with psoriasis). Lower odds were most pronounced for vaccinations against influenza and tick-borne encephalitis. These effects were consistently observed for different time frames, control cohorts and definitions of the MS cohort. Effect sizes increased towards the time of first diagnosis.
Conclusions: The results of the present study do not reveal vaccination to be associated with MS diagnosis. On the contrary, they consistently suggest that vaccination is associated with a lower likelihood of being diagnosed with MS within the next five years. This data alone does not allow for any conclusion regarding a possible protective effect of vaccinations regarding the development of MS. However, our results do not support the assumption that vaccinations are a risk factor for the development of MS.
Disclosure: Dr. Alexander Hapfelmeier received a speaker honorarium from Biogen for the Biogen Symposium on Statistical Methods in Real World Evidence 2017.
Dr. Christiane Gasperi: nothing to disclose.
Ewan Donnachie: nothing to disclose.
Dr. Bernhard Hemmer has served on scientific advisory boards for F. Hoffmann-La Roche Ltd, Novartis, and Bayer AG; he has served as DMSC member for AllergyCare and TG Therapeutics; he or his institution have received speaker honoraria from Medimmune, Novartis, Desitin, and F. Hoffmann-La Roche Ltd; his institution has received research support from Chugai Pharmaceuticals; holds part of two patents; one for the detection of antibodies and T cells against KIR4.1 in a subpopulation of MS patients and one for genetic determinants of neutralizing antibodies to interferon β.

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