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Timing MS Medications with COVID-19 mRNA Vaccines

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Based on expert consensus and available data, we offer the following guidance regarding COVID-19 vaccination for people on MS disease modifying therapies (DMTs).
 
The Pfizer BioNTech and Moderna vaccines are safe for people with MS and they are safe to use with MS DMTs1. Most DMTs are not expected to affect the responses to the Pfizer BioNTech or Moderna vaccines, though some (see details below) may make the vaccines less effective and coordinating the timing of vaccine administration with these DMTs may provide the best vaccine response2.

Given the potential serious health consequences of COVID-19 disease, getting the vaccine when it becomes available to you may be more important than optimally timing the vaccine with your DMT.

The decision of when to get the COVID-19 vaccine should include an evaluation of your risk of COVID-19, including your occupation, and the current state of your MS. Work with your MS healthcare provider to determine the best schedule for you. If the risk of your MS worsening outweighs your risk of COVID-19, do not alter your DMT schedule and get the vaccine when it is available to you.

If your MS is stable, consider the following adjustments in the administration of your DMT to enhance the effectiveness of the vaccine:

Avonex, Betaseron, Copaxone, Extavia, glatiramer acetate, Glatopa, Plegridy, Rebif, Aubagio, Bafiertam, dimethyl fumarate, Tecfidera, Tysabri and Vumerity

If you are about to start one of these DMTs for the first time, do not delay starting it for your vaccine injection. If you are already taking one of these DMTs, no adjustments of your DMT administration are needed2.

Gilenya, Mayzent, Zeposia

If you are about to start Gilenya, Mayzent or Zeposia, consider getting the Pfizer BioNTech or Moderna COVID-19 vaccine so that the second vaccine injection is done 4 weeks or more prior to starting Gilenya, Mayzent or Zeposia.  If you are already taking Gilenya, Mayzent or Zeposia, continue taking as prescribed and get vaccinated as soon as the vaccine is available to you.

Lemtrada and Mavenclad

If you are about to start Lemtrada or Mavenclad, consider getting the Pfizer BioNTech or Moderna COVID-19 vaccine so that the second vaccine injection is done 4 weeks or more prior to starting Lemtrada or Mavenclad. If you are already taking Lemtrada or Mavenclad, consider administering the vaccine injections starting 12 weeks or more after the last Lemtrada or Mavenclad dose, with the optimal timing of the vaccine 24 weeks or more after the last DMT dose2. When possible, resume Lemtrada or Mavenclad 4 weeks or more following the second vaccine injection. This suggested scheduling is not always possible and getting the vaccine when it becomes available to you may be more important than timing the vaccine with your DMT. Work with your MS healthcare provider to determine the best schedule for you.

Ocrevus and Rituxan (and biosimilars)

If you are about to start Ocrevus or Rituxan, consider getting the Pfizer BioNTech or Moderna COVID-19 vaccine so that the second vaccine injection is 4 weeks or more prior to starting Ocrevus or Rituxan. If you are already taking Ocrevus or Rituxan, consider getting the vaccine injections 12 weeks or more after the last DMT dose3. When possible, resume Ocrevus or Rituxan 4 weeks or more following the second vaccine injection. This suggested scheduling is not always possible and getting the vaccine when it becomes available to you may be more important than timing the vaccine with your DMT. Work with your MS healthcare provider to determine the best schedule for you.

Kesimpta

If you are about to start this DMT, consider getting the Pfizer BioNTech or Moderna COVID-19 vaccine so that the second vaccine injection is 4 weeks or more prior to starting your DMT. If you are already taking Kesimpta, consider getting the vaccine injections 4 weeks after your last Kesimpta injection. When possible, resume Kesimpta injections 4 weeks or more following the second vaccine injection. This suggested scheduling is not always possible and getting the vaccine when it becomes available to you may be more important than timing the vaccine with your DMT. Work with your MS healthcare provider to determine the best schedule for you.

High-dose steroids

Consider getting the vaccine injections 3-5 days after the last dose of steroids.

Read our complete guidance on COVID-19 mRNA vaccines. Read the complete MS Treatment Guidelines During COVID-19.

References

  1. Farez M, Correale J, Armstrong M, et al. Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2019;93(13):584-594.
  2. Ciotti J, Valtcheva M, and Cross A. Effects of MS disease-modifying therapies on responses to vaccinations: A review. Multiple Sclerosis and Related Disorders 2020;45:102439.
  3. Bar-Or A, Calkwood J, Chognot C, et al. Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis: The VELOCE study. Neurology 2020;95(14):e1999-e2008.

The National MS Society consulted the following individuals in the development of this guidance:

MS neurologists and experts

  • ​Nancy Sicotte, MD, FAAN—Chair, National MS Society’s National Medical Advisory Committee, Cedars-Sinai Medical Center, USA
  • Brenda Banwell, MD— Chair of MS International Federation International Medical and Scientific Advisory Board (IMSB) – University of Pennsylvania, USA
  • Amit Bar-Or, MD, FRCPC—President, International Society for Neuroimmunology - University of Pennsylvania, USA
  • Jorge Correale, MD-- Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina
  • Anne Cross, MD, FAAN—Washington University and Secretary of Board of Governors of the Consortium of MS Centers, USA
  • Jaime Imitola, MD, FAAN—University of Connecticut, UConn Health, USA
  • Dorlan Kimbrough, MD—Duke University, USA
  • Avindra Nath, MD—National Institutes of Health/National Institutes of Neurological Disorders and Stroke, USA
  • Scott Newsome, DO, MSCS, FAAN, FANA—Johns Hopkins University and President of the Board of Governors of the Consortium of MS Centers, USA
  • Penny Smyth, MD, FRCPC—University of Alberta, Canada
  • Rachael Stacom, MS, ANP-BC, MSCN—Independence Care System, USA

Staff from MS Partner Organizations

  • Julie Fiol, RN, MSCN—National MS Society, USA
  • Pamela Kanellis, PhD—MS Society of Canada
  • Julie Kelndorfer—MS Society of Canada
  • Jennifer McDonell—MS Society of Canada
  • Hope Nearhood, MPH, PMP—National MS Society, USA
  • Leslie Ritter—National MS Society, USA
This guidance is endorsed by the Consortium of Multiple Sclerosis Centers and the following organizations:

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© 2020 The National Multiple Sclerosis Society is a tax exempt 501(c)3 nonprofit organization. Its Identification Number (EIN) is 13-5661935.