Multiple Sclerosis and COVID-19 Vaccination: What We Know So Far

Data on the safety and efficacy of COVID-19 vaccination continue to emerge, as well as questions about whether the available COVID-19 vaccines are safe and effective for patients with multiple sclerosis (MS) in particular. Organizations such as the National Multiple Sclerosis Society (NMSS) have issued guidance to address COVID-19 vaccination among patients with MS, based on currently available data.

Neurology Learning Network (NLN) discussed COVID-19 vaccination recommendations for patients with MS with Farrah Mateen, MD, PhD, who is an associate professor at Harvard Medical School, director of Global Health in the Department of Neurology, and associate director of the Multiple Sclerosis & Neuromyelitis Optica Unit at Massachusetts General Hospital in Boston.

NLN: Could you talk about current recommendations for patients with MS when it comes to COVID-19 vaccination?

Dr Mateen: The COVID-19 vaccine is gradually being rolled out, and we are still learning as we go. There are currently 2 COVID-19 vaccines in the United States that have been authorized for emergency use by the FDA. One is the Pfizer-BioNTech vaccine, and there is the Moderna vaccine, both of which are manufactured within the United States. More vaccines, such as the Johnson & Johnson vaccine, will probably be authorized for emergency use by the FDA in the future.

NMSS released consensus guidelines in January 2021, which will continue to evolve, but are fairly generic at the moment. Right now, we know that the COVID-19 vaccines are safe. In my experience, many patients have come to me asking whether it is safe for them to get the vaccine in conjunction with their pharmacologic treatments for MS. As you know, there are more than 20 FDA-approved drugs for MS right now.

We may see various updates on efficacy over time, but the key point right now is that these vaccines are safe. Going forward, there are many additional questions around vaccine timing and efficacy among patients with MS depending on which drug they are taking, comorbidities, and age for example.

NLN: How can providers reassure their patients with MS that the COVID-19 vaccine is safe for them and help ease any feelings of hesitancy or anxiety around it?

Dr Mateen: It is important to ask patients what their concerns are and whether they have heard anything about the vaccine that is concerning to them. Patients are sometimes looking for reassurance that a neuroimmunology specialist has considered the data specifically as it relates to MS, and some are looking for the vaccine itself and wondering whether their neurologist can administer it to them. There are many issues around coordination in the United States in terms of where and when to get the vaccine, as well as vaccine eligibility. Different states have different criteria for vaccine eligibility.

I, along with many other health care workers, have already received the vaccine, and I have been able to reassure my patients with that experience. Furthermore, the data from the vaccine trials themselves are very reassuring. Among tens of thousands of people who received these FDA-approved COVID-19 vaccines during the trials, there were no adverse events that would cause concern about its effects among patients with MS.

NLN: What areas of future research are still needed when it comes to COVID-19 vaccination among patients with MS or any subpopulations with MS?

Dr Mateen: I think efficacy is the biggest question going forward. We know that the vaccine is safe, but how well does it work among patients with MS on various treatments? The biggest question is, if the vaccine does not work as well among patients with MS, are they still protected to a sufficient degree by the vaccine? It is worth noting that the vaccines for COVID-19 are modified RNA vaccines, which are a new type of vaccine for which we have very little precedent compared with other types of vaccines for other viruses.

I think a priority group going forward is patients who are treated with B-cell therapies, such as rituximab, ocrelizumab, and ofatumumab. We know that B cells are important for vaccines, but in this case, we do not yet have enough data to show whether the vaccine will be as effective in this subpopulation compared with the general population. If the data show that the vaccine is less effective in these patients, then the next questions could include, is a booster dose needed, and what other steps can these patients take for protection against COVID-19? This also brings about more nuanced questions such as, should these patients delay a dose of their B-cell therapy, or should they try to time the vaccine with their B-cell therapy dosing, which remains controversial.

For example, in their guidance, NMSS recommends that patients attempt to receive the vaccine 12 weeks or more after their B-cell therapy dose. This may be really difficult to coordinate in the United States based on how the vaccines are rolling out. I have actually been telling my patients to get the vaccine whenever they become eligible. I do not believe we have enough data right now to suggest timing of the vaccine based on when patients receive the next dose of their B-cell therapy.

NLN: What key take-home message would you like to leave with our audience?

Dr Mateen: COVID-19 has obviously taken us by storm around the world. The vaccine is a major advance for science in terms of its safety and how quickly the vaccine was developed and tested. Studies addressing vaccine acceptability and vaccine registries are starting to be conducted. Now that people are receiving the vaccines and we are able to obtain more and more data globally, recommendations will continue to solidify, and comfortability with the vaccine will increase. I hope people are interested in participating in research studies of the COVID-19 vaccine, many of which are observational.

At this point, I am recommending COVID-19 vaccination to all of my patients. The vaccine appears to be safe, as well as effective, based on data that continue to emerge. It may not deliver the same efficacy for all patients, but we also know that the benefits of vaccination far outweigh the risks.

—Christina Vogt

Published in partnership with American Neurological Association

Reference:
COVID-19 vaccine guidance for people living with MS. National Multiple Sclerosis Society. Updated on February 10, 2021. Accessed February 11, 2021. https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance