Table 5.

Summary of recommendations on vaccination against COVID-19 for people about to receive, or already receiving, a disease-modifying therapy (DMT)

DMT	New DMT starts	Ongoing DMT therapy
Interferon-β, teriflunomide, dimethyl fumarate, glatiramer acetate, natalizumab, cladribine tabletsa	Vaccinate (any vaccine) while starting or continuing treatment, with no modification of the MS treatment plan. Applies to new DMT starts and continuing DMT therapy
Fingolimod	Vaccines other than OxAZ  Vaccinate 4–6 weeks before starting OxAZ vaccine  1st dose 2–4 weeks before starting  2nd dose 3 months after starting	Vaccinate in the absence of other contraindications This applies to all COVID-19 vaccines
Anti-CD20	Vaccines other than OxAZ  Vaccinate 4–6 weeks before starting	Vaccines other than OxAZ  Vaccinate 4–5 months after last infusion  Delay the next dose by 6 weeks after full course of vaccineb
	OxAZ vaccine  1st dose 6 weeks before 1st infusion  2nd dose 4–5 months after next infusion, and ≥ 6 weeks before the following infusion	OxAZ vaccine  1st dose 4–5 months after last infusion and 6 weeks before next infusion  2nd dose 4–5 months after next infusion, and 6 weeks before the following Infusion
Alemtuzumab	Vaccines other than OxAZ  Vaccinate 4–6 weeks before starting OxAZ vaccine  1st dose 6 weeks before 1st infusion  2nd dose ≥ 3 months	Vaccines other than OxAZ  Vaccinate ≥ 3 months after starting treatment OxAZ vaccine  1st dose ≥ 3 months after the treatment course  2nd dose at least 6 weeks before other courses of alemtuzumab. The second course can be delayed for several months to facilitate advance scheduling of vaccination

OxAZ Oxford University/AstraZeneca vaccine against COVID-19

^aFor patients receiving ongoing treatment with cladribine tablets, it is preferred to vaccinate if the lymphocyte count is more than 500/mm³

^bNote that a given vaccine may require one or two doses (see Table 4)