We asked our medical advisers to answer your questions about what the new coronavirus vaccine means if you're on an MS treatment. This is their consensus statement.
After a tough year for everyone, in late 2020 we saw some light at the end of the tunnel. Two coronavirus vaccines were approved by the UK government and Medicines and Health products Regulatory Agency (MRHA). The first, on 2 December, was developed by Pfizer-BioNTech. The second, on 30 December, was developed by Oxford University and AstraZeneca. There are more candidates in the pipeline.
But what does this mean for people living with MS? Our MS Society Medical Advisers, who are some of the leading clinicians for MS in the UK, have addressed some of your questions about disease modifying therapies (DMTs) and the vaccine. This is their consensus statement.
Consensus statement from MS Society medical advisers - first published 10 December 2020 and updated 6 January 2021
Based on what we know about the way these vaccines work, and high quality evidence from studies of other vaccines and MS, we don’t think they will exacerbate MS or its symptoms, provoke a relapse, or prevent DMTs from being effective. We have no reason to believe any COVID-19 vaccine will be dangerous for people with MS, including those on immunosuppressive drugs.
Furthermore, none of the leading COVID-19 candidate vaccines are ‘live’ – meaning they don’t contain any virus capable of causing infection – so should be safe for people on all types of disease modifying therapy.
MS DMTs and COVID-19 vaccine effectiveness
Some DMTs might reduce the effectiveness of any vaccine because they prevent the immune system from mounting a complete immune response to the vaccine. Therefore, the COVID-19 vaccine might be less effective for people that have recently taken or are taking certain DMTs.
Overall, it will generally not be advisable for people to substantially alter their MS treatment in hopes of increasing the efficacy of vaccines, because the potential harm would outweigh the potential benefit. Even a reduced response is likely to be better than none, so you should still get vaccinated even if on these therapies.
Here are of our detailed thoughts on some DMTs and how they may impact on the effectiveness of COVID-19 vaccines:
Ocrelizumab (Ocrevus) and fingolimod (Gilenya)
- Ocrelizumab (Ocrevus) may reduce the response to some vaccines by up to 50%. It may be beneficial to delay your first course of ocrelizumab in order to get the vaccine first. In general there would be limited benefit in delaying a second or third course in hopes of increasing vaccine effectiveness. We would have similar advice for anyone receiving rituximab.
- A reduced response may also be seen with fingolimod (Gilenya). In general it would not be advisable to stop treatment in order to increase immune response to the vaccine.
Alemtuzumab (Lemtrada) and cladribine (Mavenclad)
- There may be a reduced response to a vaccine soon after alemtuzumab (Lemtrada) treatment, so waiting 3 months after an infusion before having a vaccination is recommended.
- There may be a reduced response to a vaccine with cladribine (Mavenclad) and it may be advisable to wait 3 months after a course before having a vaccine.
- We note that a second course of alemtuzumab or cladribine is usually given after 12 months, but this can safely be delayed for several months without concerns for a return of disease activity, allowing some flexibility to schedule vaccination in advance.
Delays to start treatment
For all 4 treatments mentioned above (ocrelizumab, fingolimod, alemtuzumab, and cladribine), if starting for the first time, you should discuss with your team whether it might be preferable to wait until you have been vaccinated. The risks of this strategy will depend on your individual case and on the availability of the vaccine.
Haematopoietic stem cell transplantation
Haematopoietic stem cell transplantation (HSCT) will likely reduce response to the vaccine. You should wait at least 6 months after treatment before getting vaccinated.
We have no reason to believe other DMTs available on the NHS will reduce efficacy of vaccines. This covers: glatiramer acetate (Copaxone and Brabio), teriflunomide (Aubagio), dimethyl fumarate (Tecfidera), beta interferons, and natalizumab (Tysabri).
Other important points
The current vaccines all require 2 doses and for some treatments (for example ocrelizumab, cladribine, or alemtuzumab) your MS team may advise you on specific timing in relation to this. For example you may be advised to wait after your second dose of vaccine before a further course of DMT – or to resume treatment after a single dose of vaccine (delaying the second).
You should leave at least a 7-day gap between getting the flu vaccine and a COVID-19 vaccination.
Until we know more about the vaccine, everyone with MS should continue to follow government advice to reduce the risk of catching and transmitting COVID-19 even if they have received a vaccine for COVID-19. People that are on the clinically extremely vulnerable list should continue to take extra precautions to protect themselves from catching the virus.
We would particularly emphasise that it takes some time after vaccination to achieve immunity, so it is crucial to maintain precautions after initial vaccination. It takes up to 28 days after the first dose of the Pfizer-BioNTech vaccine and up to 22 days for the Oxford-AstraZeneca vaccine to get some level of immunity. For both vaccines, the best response is achieved with two doses and you should receive the second booster dose when offered, but there is significant protection from a single dose.
Everyone's risk is different and will depend on individual circumstances. You should have an opportunity to discuss the right choice for you with your MS team. Please note you do not need to contact your team to ask for the vaccine, you will be contacted proactively by your GP.
There is lots we don’t yet know about the effectiveness of these vaccines for people with MS, and those taking DMTs. We understand this might make a decision regarding your care and treatment hard to make. Please be assured we’re constantly reviewing the guidance, data and information to better understand this, and we’ll do our absolute best to keep the MS community informed.
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How we can help
We're here for you. If you’re worried about your MS and coronavirus and want to chat to someone, call our MS Helpline on 0808 800 8000. We’re here Monday to Friday, 9am to 7pm except bank holidays.