MS medications can affect timing of Pfizer and Moderna vaccines, but shouldn’t stop immunization

Based on the data so far, the Pfizer and Moderna COVID-19 vaccines are considered safe for people with multiple sclerosis and safe to use while on disease-modifying therapies, but deciding when to get the vaccine will depend on each patient’s medication regimen.

Based on the data so far, the Pfizer, Moderna and Johnson & Johnson vaccines for COVID-19 are considered safe for people with multiple sclerosis (MS) and safe to use while on disease-modifying therapies, according to Geeta A. Ganesh, M.D., a Norton Neuroscience Institute neurologist who specializes in MS care. Coordinating the vaccine with some MS medications may improve the body’s immune response.

“Most people with relapsing and progressive forms of MS should get vaccinated. The timing of the vaccine can depend on what is available to you, how stable your MS is and what medication you are on,” she said.

“People with MS who are experiencing a serious relapse that affects their ability to carry out activities of daily living should wait before considering any vaccine,” Dr. Ganesh said. “The recommendation is to wait four to six weeks after the onset of relapse symptoms or wait until symptoms have stabilized.”

While there have been no clinical trials of the vaccines specifically with MS volunteers, a review of existing clinical trial data and studies of other vaccines in MS patients helped scientists develop the following guidelines.

MS patients getting the vaccine should not delay starting the following medications or alter their dosing or frequency. These are interferons, glatiramer acetates, teriflunomide, forms of dimethyl fumarate, diroximel fumarate and natalizumab.

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Norton Neuroscience Institute brings a multidisciplinary approach to multiple sclerosis care. Neurologists along with dedicated psychiatric providers, pharmacists and social workers function as a team to manage patients’ MS.

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Beta interferons

  • Avonex
  • Betaseron
  • Extavia
  • Plegridy
  • Rebif

Glatiramer acetates

  • Copaxone
  • Glatopa
  • Generic glatiramer

Additional medications

  • Aubagio
  • Bafiertam
  • Dimethyl fumarate (generic)
  • Tecfidera
  • Tysabri
  • Vumerity

The following suggested scheduling may not be possible in every case, and getting vaccinated against COVID-19 promptly may be more important. Work with your MS specialist to determine the best approach for you.

If you are due to start on any of the following therapies, it’s best to get the second Pfizer or Moderna vaccine dose or the sole Johnson & Johnson dose two to four weeks or more before starting. Those already on these medications should continue as prescribed and get the vaccine.

  • Gilenya
  • Mayzent
  • Ponvory
  • Zeposia

Lemtrada

Starting Lemtrada: The final Pfizer or Moderna dose or the sole Johnson & Johnson injection should be four or more weeks prior to the start of the medication.

Already taking Lemtrada: If you are already on Lemtrada, the most optimal timing is 24 or more weeks after the last dose of medication.

Subsequent courses of Lemtrada: Start any subsequent treatment courses four weeks or more after your final dose of vaccine.

Mavenclad and Kesimpta

Starting Mavenclad or Kesimpta: Get the final or sole vaccine dose two to four weeks ahead of time.

Already taking Mavenclad or Kesimpta: For those already taking Mavenclad or Kesimpta it doesn’t appear they will have any effect on your immune response to the vaccine.

Subsequent courses of Mavenclad or Kesimpta: If you are due for another course of Mavenclad or Kesimpta, consider starting two to four weeks after your final vaccine dose.

Ocrevus, Rituxan and rituximab biosimilars

Starting Ocrevus, Rituxan or rituximab biosimilars: The only Johnson & Johnson dose or, in the case of Pfizer and Moderna the final vaccine dose, should be given two to four or more weeks prior to the start of these medications.

Already taking Ocrevus, Rituxan or rituximab biosimilars: If you are already on these medications, consider getting the vaccine 12 or more weeks after the last treatment dose.

Resuming Ocrevus, Rituxan or rituximab biosimilars: If you are resuming these medications after the last dose of vaccine, it is recommended that you wait four or more weeks to do so.

High-dose steroids

Consider getting the vaccine at least three to five days after the last dose.


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Vicki L. Owczarzak, M.D.

Vicki L. Owczarzak, M.D., is a pediatric otolaryngologist at Norton Children’s ENT & Audiology, affiliated with the UofL School of Medicine, and an assistant professor at the medical school.

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