The Canadian Network of MS Clinics has updated its COVID vaccine recommendations following a report of a reduced vaccine response in MS patients receiving fingolimod or ocrelizumab (see Few vaccine responders with fingolimod, ocrelizumab, NeuroSens, April 23, 2021).
Treatment interruption or a change in therapy is not advised for patients receiving an S1P antagonist or anti-CD20 agent prior to vaccination. However, clinicians may consider starting patients on a different disease-modifying therapy (DMT) until after vaccination has been completed.
“At this time, we feel it is premature to make any definitive statement,” stated Dr. François Grand’Maison, Greenfield Park, Quebec, in an email to NeuroSens. “[T]here [are] data that some anti-CD20 drugs and S1P receptor agonists are associated with reduced SARS-Cov2 antibody responses with at least one of the mRNA vaccines. Similar data may emerge with other DMT or with other vaccines, but until then we would still recommend that all our patients get vaccinated regardless of the DMT they are using.”
The statement was provided by Dr. Grand’Maison on behalf of the Network’s COVID vaccine working group. Other members include Drs. Virginia Devonshire, Vancouver, BC; Jodie Burton, Calgary, Alberta; Mark Freedman, Ottawa, Ontario; and Penny Smyth, Edmonton, Alberta.
The Network’s recommendation of January 31, 2021, is not to modify the dosing in patients receiving an S1P antagonist (fingolimod, siponimod, ozanimod) prior to vaccination (https://cnmsc.ca/Covid19VaccineGuidance). For ocrelizumab and rituximab, the recommendation is to delay vaccination as late from the previous infusion as is reasonable (e.g. 4-6 months). For ofatumumab, the recommendation is to administer the vaccine 4 weeks after the last subcutaneous injection, and resume ofatumumab 4 weeks after the second vaccine dose.
One change in the updated recommendations is that for patients scheduled to start or switch to an S1P antagonist or anti-CD20 agent, an alternative agent may be considered. “[U]sing a different DMT (other than an anti-CD20 or S1PR agonist) until they have completed their vaccination protocols might be a consideration,” the Network said. Patients should also be advised to wear a mask and maintain physical distancing.
The updated recommendations follow a study in Israel of 125 MS patients that found that only 3.8% of fingolimod-treated patients mounted a protective IgG antibody response to the Pfizer vaccine (Achiron et al. Ther Adv Neurol Disord 2021:14:1-8). In the ocrelizumab group, only 22.7% mounted an antibody response when vaccine was administered up to 8.9 months after the last dose (median 4.9 months).