The pandemic and the discussions about vaccinating MS patients against COVID19 have shown the need for a common European approach regarding recommendations for vaccinating MS sufferers. Therefore, after the last ECTRIMS Congress in 2020, representatives of the ECTRIMS (European Committee for Treatment and Research in MS) and the EAN (European Academy of Neurology) came together to formulate common European standards for the vaccination of MS sufferers. These standards were presented at the ECTRIMS Congress 2021.
Reduced vaccine response? – Still vaccinate.
Statements were made on the topics of safety, effectiveness and vaccination strategy under immunotherapies and in special situations (such as pregnancy or pediatric MS). European experts consider vaccinations in MS patients to be generally safe – there is no increased risk for an MS or the occurrence of a first demyelinating event, a connection between relapses or disease progression and vaccinations is also not seen. Basically, there is no difference between MS patients and the general population when it comes to the vaccine response.
As far as the vaccine response under immunotherapy is concerned, certain differences between individual substance groups are seen, a reduced vaccine response with treatment with anti-CD20 antibodies and S1P modulators (such as Fingolimod) can be assumed based on the current data situation, but this does not mean a contraindication for the use of inactivated vaccines.
Recommended vaccinations for Multiple Sclerosis
Inactivated vaccines can be used safely in MS patients regardless of the MS therapy. However, there is a contraindication for the use of attenuated live vaccines under immunosuppressive therapy. The European position paper generally recommends updating the vaccination protection as early as possible in the course of MS, before starting an immunotherapy. In addition to the
- basic immunizations
- a regular vaccination against influenza,
- protection against pneumococci,
- as well as the vaccination against HPV (human papillomavirus)
are recommended, especially if a therapy with Alemtuzumab, Cladribin, S1P modulators or anti-CD20 antibodies is planned. For MS sufferers over 50 years of age, a vaccination against
- Herpes zoster (shingles)
is advised with the aforementioned drugs. Patients receiving anti-CD20 antibodies should be immunized against
- Hepatitis
It thus becomes apparent that there is quite a broad consensus in Europe regarding the necessity of vaccinating MS sufferers – and personally, I am pleased that the statements largely coincide with what has been said by me in the blog and also in various video contributions about the vaccination of MS sufferers.
I want to conclude this post about vaccination with the mention of a presentation by Anat Achiron from Israel, which has caused excitement and will surely soon be hotly debated among MS sufferers.
Don’t stop Fingolimod
Ms. Prof. Achiron was one of the first to publish vaccination data from MS sufferers in Israel (see DocBlog from 26.04.2021). She showed that both patients treated with anti-CD20 therapies (Rituximab, Ocrelizumab see ECTRIMS 2021 (1)) and patients treated with S1P modulators (e.g. Fingolimod) do not develop sufficient antibodies against SARS-CoV2.
At ECTRIMS 2021, she also presented data on the T-cell response and reported that she found no T-cell response at all in Fingolimod patients. These are interesting data, but they will not go unchallenged. From the point of view of many experts, there could be a methodological problem here, as blood from Fingolimod patients may yield insufficient material due to lymphopenia.
Therefore, the recommendation given by Ms. Prof. Achiron on the basis of her data, namely to stop Fingolimod before a vaccination, was considered excessive and possibly even counterproductive, since stopping Fingolimod can be associated with an increased risk of disease activity – and there is a general consensus in Europe, as reported above, to vaccinate MS patients against COVID19, regardless of the current MS immunotherapy.
