A/Prof Anneke van der Walt
The immunisation status of patients newly diagnosed with MS must be assessed when beginning treatment with disease-modifying therapies (DMTs), according to a commentary article by neurologists in the MJA.
A key aspect to consider is that live vaccinations are contraindicated in patients once they have commenced a DMT, according to the authors led by Dr Cassie Nesbitt, a neurologist at Alfred Health in Melbourne.
“Live vaccinations use an attenuated viral or bacterial strain and are contraindicated with most DMTs because of the risk of disseminated infection when used in immunocompromised states. Administration of live vaccines is recommended before DMT commencement,” they wrote.
Therefore careful planning from early in the treatment course is key, with an individualised approach to risk–benefit assessment when considering vaccinations.
“A full course of vaccinations should be considered for non-immune patients before commencing a DMT; this is sometimes forgotten in the urgency of managing a new MS diagnosis, the authors said.
Routine vaccinations were not associated with increased MS relapse risk, they emphasised, and immunisations administered in accordance with local guidelines were considered the best strategy for minimising the risk of infections that could trigger MS relapses.
In patients experiencing clinically significant relapses, delaying vaccine administration has been suggested until patients have stabilised and show signs of improvement, typically 4–6 weeks, they noted.
Their perspective article provides specific guidance on vaccination in relation to MS therapies such as corticosteroids, terflunomide, dimethyl fumarate, fingolimod, cladribine, natalizumab, alemtuzumab, ocrelizumab and rituximab.
The guidance includes recommendations on how long to delay therapy after receipt of live vaccine and the optimum washout period before giving a live vaccine to avoid prolonged effects of DMTs on the immune system
“Although we consider it safe to combine non-live vaccinations with DMTs, data are limited regarding their efficacy and durability,” they advised.
Associate Professor Anneke van der Walt, a neurologist at Monash University and the senior author on this study, will also be leading a study to determine if people with MS on different MS treatments will develop sufficient protective immune responses after receiving a Covid-19 vaccine.
She and the MSNI Unit at The Alfred will be collaborating with Associate Professor Fabienne Brilot from Sydney Children’s Health Network.
“This is important to determine as MS treatments generally suppress the immune system and a normal response to a vaccine may be blunted or diminished,” she said.
The study aims to also determine how long the effect of the vaccine last for people with MS on treatments. Lastly, we will be determining if people with MS will be protected from the new strains of the Covid-19 virus after receiving a vaccine.”