The vaccination campaign in Germany against COVID19 is in full swing. It now seems to be more of a problem to get the vaccine to people. Many MS patients have also been vaccinated by now. This is very pleasing, as a completed vaccination certainly prevents serious and fatal courses of illness and also protects against the Delta variant. This is clearly shown in the evaluation of population-based studies (Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant) – The primary goal of the vaccination campaign is thus achieved.
Another observation should convince MS patients that vaccination is an effective concept. This is especially true if they are being treated with immunotherapy. If we look at the age group of the very old people (> 80). They have a particularly high risk of severe COVID-19 disease due to their weakened immune systems. That’s why they were vaccinated very consistently at the beginning of the pandemic. By now, infection activity is very low in this population group and the very old COVID-19 patients are no longer playing a role in hospitals.
So if it has been possible to protect elderly patients with multiple pre-existing conditions from severe COVID-19 courses, then as a vaccinated young to middle-aged adult with MS you should not be overly worried. And this also applies to patients who are being treated with immunotherapy. Even if the current treatment with anti-CD20 antibodies or S1P modulators is being carried out, which have recently performed poorly in studies regarding the formation of neutralizing antibodies against SARS-CoV2.
Clinical benefit of a 3rd vaccination unclear
Despite the generally positive news about the effect of a complete mRNA or vector vaccination, there seems to be a feeling of panic spreading everywhere. And this panic is leading to absolutely nonsensical actions among MS patients. For example, I recently heard about the case of a woman in her mid-30s whose MS has been controlled for years by taking Fingolimod. She was advised to stop taking Fingolimod in order to receive a third vaccination against COVID-19 to achieve a better immune response. Given that stopping Fingolimod without replacement carries a high risk of rebound, the sense of a third vaccine dose is not apparent. Because at the moment it is not at all clear whether a third vaccine dose has a clinical benefit. And so the examples of interventions in existing MS therapies in favor of better vaccination success are piling up without the risk of therapy modification being reasonably weighed.
From the very beginning of the pandemic, most MS experts have pointed out that therapy modifications with the aim of possible protection from the SARS-Coronavirus are not useful and the therapy should always be based on the requirements of the disease. Therefore, it also seems advisable at the present time that necessary therapies should not be modified in favor of vaccination success. Especially if such a modification affects the effectiveness of the therapy.
It is conceivable that an official recommendation for a third vaccination for certain patient groups will be issued in the fall. This will presumably also include MS patients who are treated with certain medications. But until such a recommendation is issued, there is no reasonable reason for the application of individual vaccination schedules for MS patients. Certainly not when it involves modifying a successful MS therapy.
A current video on the topic of Multiple Sclerosis and Vaccination
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