ECTRIMS-EAN consensus on vaccination in MS patients

The first-ever European position statement on SARS-CoV-2 vaccination for patients with MS was presented at the 2021 ECTRIMS meeting on behalf of ECTRIMS and the European Academy of Neurology (EAN). The consensus document consists of 59 recommendations on the best vaccination strategy for patients with MS, according to the latest evidence and expert knowledge [1].

Dr Mauricio Farez (Fundacion FLENI, Argentina) presented the recommendations and conclusions from the ECTRIMS/EAN consensus for vaccination against SARS-CoV-2 in MS patients. For each clinical question, a systematic literature search was conducted considering published studies, guidelines, and position statements. The first and most relevant question that the consensus committee set out to answer was whether MS patients are at a higher risk of COVID-19 or experience a more severe form of the disease. Dr Farez explained that the studies published so far are overall reassuring and do not suggest major safety issues. The main factors associated with more serious forms of COVID-19 in patients with MS are similar to those in the general population. These include age, obesity, diabetes, sex, and ethnicity. Treatment with interferons and glatiramer acetate does not increase the risk of getting COVID-19 or worsen its clinical course. Fingolimod, teriflunomide, natalizumab, and dimethyl fumarate do not seem to negatively affect SARS-CoV-2 infection. However, several studies show that anti-CD20 antibodies and steroid pulses can increase the risk of COVID-19.

At the time of the presentation, 4 SARS-CoV-2 vaccines were licensed for the European Union. These include 2 mRNA vaccines, Moderna and Pfizer/BioNTech, and 2 adenovirus-based vaccines, from Janssen and AstraZeneca. Five other vaccines were under review. “All 4 available vaccines can be administered to patients with MS, including those receiving immunosuppressive disease-modifying therapies,” Dr Farez said. He added that no red flags have been observed in MS patients receiving mRNA vaccines, but that continued surveillance for immune-mediated adverse events is warranted. So far, no signals have been observed that SARS-CoV-2 vaccines result in an increased relapse rate or disability worsening. No evidence is present for recommending a specific vaccine to MS patients, nor are there any specific contraindications.

Patients with normal lymphocyte counts taking interferons, glatiramer acetate, teriflunomide, or fumarates are most likely adequately protected. Patients with moderate to severe lymphopenia may not develop an adequate immune response to SARS-CoV-2 vaccination. Therefore, absolute lymphocyte count may be checked before vaccination. Patients taking natalizumab are also likely protected with SARS-CoV-2 vaccination. It is likely that MS patients taking alemtuzumab generate an attenuated immune cellular and humoral response to SARS-CoV-2 vaccines, especially in the first 6 months during maximum lymphopenia. If possible, vaccination should be delayed until at least 6 months after treatment. Patients who have completed both courses of alemtuzumab with complete immune reconstitution are expected to mount a full immune response. In studies, all cladribine-treated MS patients demonstrated a protective humoral immune response to the SARS-CoV-2 vaccine. The majority of patients treated with fingolimod have failed to show a protective level of antibodies following SARS-CoV-2 vaccination. Patients taking ocrelizumab do not mount an appropriate IgG response regardless of lymphocyte count or the time interval from the last ocrelizumab dose (3–9 months). It is advisable to administer a vaccine at least 12 weeks after ocrelizumab dosing and 4–6 weeks prior to the next dose.

 

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   1. Farez MF. Position statement on COVID-19 vaccinations in MS patients. OP182, ECTRIMS 2021 Virtual Congress, 13–15 October.

 

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Posted on 9 December 202115 February 2024