MS Society Releases Guidance on DMT Dosing Modifications for COVID-19 Vaccination

As rollout of the 2 approved vaccines for preventing coronavirus disease 2019 (COVID-19) continues, the National Multiple Sclerosis Society has issued guidance on dosing modifications for disease modifying therapies (DMTs) in patients with stable disease receiving a COVID-19 vaccine.

Earlier this year, the society released a statement urging all patients with multiple sclerosis to get vaccinated against COVID-19. The current guidance emphasizes that the Pfizer/BioNTech and Moderna vaccines, both of which are mRNA based, are safe for people with multiple sclerosis taking DMTs.

According to the society, “Most DMTs are not expected to affect the responses to the Pfizer/BioNTech or Moderna vaccines, though some may make the vaccines less effective and coordinating the timing of vaccine administration with these DMTs may provide the best vaccine response.”

For patients getting started on Gilenya (fingolimod), Mayzent (Siponimod), Zeposia (ozanimod), Lemtrada (alemtuzumab), Mavenclad (cladribine), Ocrevus (ocrelizumab), Rituxan (rituximab), or Kesimpta (ofatumumab), the recommendation is to initiate treatment at least 4 weeks following the second dose of either COVID-19 vaccine.

If patients are already on treatment with Gilenya, Mayzent, or Zeposia, they are advised to continue their treatment and get the COVID-19 vaccine when able. However, it they are already taking Lemtrada or Mavenclad, the society suggests considering waiting at least 12 weeks—optimally 24 weeks—following the last DMT dose before getting a COVID-19 vaccine.

Similarly, for patients taking Ocrevus or Rituxan, the guidance recommends waiting to receive the first dose of the vaccine at least 12 weeks after their last treatment dose and resuming DMT treatment 4 weeks after the second dose.

For treatment with Kesimpta, the guidance suggests getting the vaccine 4 weeks after their last DMT injection and resuming Kesimpta at least 4 weeks after the second vaccine injection.

“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,” reads the guidance, which advises patients to speak with their physician to determine the best schedule for them. “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.”

No DMT adjustments are needed for the following treatments: Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (glatiramer acetate), Extavia (interferon beta-1b), glatiramer acetate, Glatopa (glatiramer acetate), Plegridy (peginterferon beta-1a), Rebif (interferon beta-1a), Aubagio (teriflunomide), Bafiertam (monomethyl fumarate), dimethyl fumarate, Tecfidera (dimethyl fumarate), Tysabri (natalizumab), and Vumerity (diroximel fumarate).

Reference

National Multiple Sclerosis Society. Timing MS medications with COVID-19 mRNA vaccines. Accessed February 18, 2021. https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance/Timing-MS-Medications-with-COVID-19-mRNA-Vaccines