Timing MS
Medications with COVID-19 mRNA Vaccines
Updated
February 25, 2021
Based on expert
consensus and available data, we offer the following guidance regarding COVID-19
vaccination for people on MS disease modifying therapies (DMTs). This guidance
will be reviewed regularly and updated as new data are available. Check back
often for the most up-to-date information.
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 given2-4 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 given2-4
weeks or more prior to starting Lemtrada or Mavenclad. If you are already
taking Lemtrada or Mavenclad, consider getting 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 given 2-4
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 given 2-4 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
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 MS Centers
and the following organizations:
Accelerated Cure Project for Multiple Sclerosis
Americas Committee on Treatment and Research in Multiple Sclerosis
International Organization of Multiple Sclerosis Nurses (www.iomsn.org)
MS Views and News (www.msviewsandnews.org)
Multiple Sclerosis Association of America (www.mymsaa.org)
Multiple Sclerosis Foundation
United Spinal Association