Table 2.
Recommended safety interval between drug suspension and live-attenuated vaccine administration.
| Disease-modifying drug | Interval to live-attenuated vaccine |
|---|---|
| Interferon/glatiramer acetate | None |
| Dimethyl fumarate | Until normal lymphocyte count |
| Teriflunomide | 3.5 months–2 years (accelerated elimination: wait 1.5 months after the first result of plasma concentrations of the drug is below 0.02 mg/l). |
| Fingolimod | >2 months |
| Siponimod | 4 weeks |
| Ozanimod | 3 months |
| Ponesimod | 2 weeks |
| Natalizumab | >3 months |
| Alemtuzumab | Until normal lymphocyte count (approximately 12 months) |
| Cladribine | Until normal lymphocyte count (30–90 weeks after the last dose) |
| Rituximab | Until B-cell repletion (>12 months) |
| Ocrelizumab | Until B-cell repletion (>18 months) |
| Ofatumumab | Until B-cell repletion (approximately 40 weeks) |
| Corticosteriods a | 1 month |
| Plasma exchange | None |
| Intravenous immunoglobulin (IVIg) | 3 months b |
⩾ 20 mg/day or ⩾ 2 mg/Kg/day (if weight <10 kg) of prednisone or equivalent for at least 2 consecutive weeks.
Risk of diminished response to measles up to 1 year.
Based on:European public assessment reports (EPAR) // Rubin LG, et al. Infectious Diseases Society of America. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014 // Furer, V. et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Annals of the rheumatic diseases 79, 39-52, doi:10.1136/annrheumdis-2019-215882 (2020) // Ciotti, J. R., Valtcheva, M. V. & Cross, A. H. Effects of MS disease-modifying therapies on responses to vaccinations: A review. Multiple sclerosis and related disorders 45, 102439, doi:10.1016/j.msard.2020.102439 (2020).