Table 3.
Summary of recommendations for COVID-19 vaccination in people with MS by treatment status
| MS Treatment | Negative effect on SARS-CoV-2 vaccine response? | Timing of vaccine before starting treatment | Timing of vaccine after treatment started* |
|---|---|---|---|
| No DMT | None: having MS in isolation does not affect ability to mount a humoral response to available COVID-19 vaccines78 | SARS-CoV-2 vaccines are safe and effective for PwMS and recommended for all patients81 | N/A |
| Beta interferon | None78,93 | Do not delay starting for vaccine | No adjustments required; vaccinate when able |
| Glatiramer acetate | None78,93 | Do not delay starting for vaccine | No adjustments required; vaccinate when able |
| Teriflunomide | No data to suggest impaired response78,93 | Do not delay starting for vaccine | No adjustments required; vaccinate when able |
| Fumarates | No reduction in humoral or T cell-dependent responses for dimethyl fumarate; unknown for other fumarate DMTs93,105 | Do not delay starting for vaccine | No adjustments required; vaccinate when able |
| S1P receptor modulators | Impairment in humoral response in PwMS on fingolimod92 | Vaccinate at least 2 weeks before starting | Continue taking the medication as prescribed and vaccinate when able |
| Natalizumab | No data to suggest impaired responses for SARS-CoV-2 vaccines93,105 | Do not delay starting for vaccine | No adjustments required; vaccinate when able |
| Anti-CD20 monoclonal antibodies | Impairment in humoral response was observed in several studies, however certain T cell responses were found to be more robust78,86,87,90,106 | Vaccinate at least 2 weeks before starting | Ideal timing to vaccinate is 4 weeks before next infusion or 4 weeks after last dose of ofatumumab |
| Cladribine | Empiric data suggest no impairment in humoral antibody responses; theoretical concern during lymphodepletive treatment phase84 | Vaccinate at least 2 weeks before starting | No adjustments required; vaccinate when able |
| Alemtuzumab | Empiric data suggest no impairment in humoral antibody responses; theoretical concern during lymphodepletive treatment phase93 | Vaccinate at least 4 weeks before starting | Consider vaccination 24 weeks or more after the last infusion |
| High-dose corticosteroids | Not demonstrated with empirical data but theoretical concern exists given mechanism of action | Vaccinate 3-5 days after last dose | Vaccinate 3-5 days after the last dose |
*Note that ideal timing of therapy with vaccination may not be possible. Abbreviations: DMT – disease-modifying therapy; S1P – sphingosine-1 phosphate; PwMS – people with MS.