Montefiore in the News

MS experts recommend that people with MS and their household members get the COVID-19 vaccine.

Infection with COVID-19 is riskier for people with MS than getting vaccinated against it. The COVID-19 pandemic has been a challenging time for everyone, particularly those with chronic health conditions such as multiple sclerosis (MS), because of concerns about possible increased risk of serious illness.

The good news is that simply having MS doesn’t make a person more likely to become infected with COVID-19 or to have a severe case or die from it. But some groups of people with MS are more likely to become seriously ill if they get COVID-19. Those include people with progressive MS; people over age 60; men; Black Americans and possibly people of South Asian ancestry; people with higher levels of MS-related disability; people who have obesity, diabetes, or heart or lung disease; and people who take certain disease-modifying therapies (DMTs), according to the National Multiple Sclerosis Society (NMSS).

Now that vaccines that offer protection against the virus have become available, one question is likely top of mind: Is it safe for me to get vaccinated if I have MS and am on treatment for it?

The answer is, yes — though there are some things to consider.

COVID-19 Infection Riskier Than COVID-19 Vaccine for People With MS

“Overall, getting the COVID-19 infection is still more risky than getting the vaccine, for people with MS in particular, as the virus can cause new neurological attacks, return of old neurological symptoms called pseudo-exacerbations, more fatigue and cognitive fog, severe headaches, and other complications,” says Lauren Gluck, MD, the director of the Montefiore Multiple Sclerosis Center and an assistant professor at Albert Einstein College of Medicine in New York City.

“Since these vaccines are not ‘live’ vaccines — that is, they don’t contain actual viral particles — there’s no chance of getting the actual infection from the vaccine, even if you are on immunosuppressing therapies for MS,” Dr. Gluck adds.

Indeed, NMSS is generally recommending that people with relapsing and progressive forms of MS get vaccinated against COVID-19 — the studies to date have shown that the shots are safe and effective. In addition, members of the same household and close contacts of those with MS should be vaccinated against COVID-19 when possible to decrease the impact of the virus on family and friends with the condition.

The Best Time for Vaccination May Depend on Your MS Treatment

Still, the NMSS and other groups are urging those with MS to talk to their doctors first to make sure they coordinate COVID-19 vaccination with their treatment. That’s because it’s possible the vaccine, which requires two doses, won’t be as effective for those on certain disease modifying therapies, depending on when you get inoculated during your regular treatment schedule.

To maximize the efficacy of your vaccine, if you’re taking the DMTs Kesimpta (ofatumumab), Lemtrada (alemtuzumab), Mavenclad (cladribine), Ocrevus (ocrelizumab), or Rituxan (rituximab), you may need to coordinate the timing of your vaccine with the timing of your DMT dose. The timing depends on which DMT you’re using, but as described in an August 2020 article in CNS Drugs, research suggests that ideally, for maximum protection, you should get vaccinated toward the end of your MS treatment cycle, up to four weeks before your next scheduled injection or dose of pills.

“Based on data about other vaccine responses while on these drugs, I recommend waiting four to five months after your last Ocrevus or Rituxan infusion or talking to your doctor about whether to delay your Kesimpta injections,” says Gluck. “Making these adaptations to treatment will give you the best chance of an effective vaccine response. Taking the vaccine without these changes will not be dangerous but may not produce a robust immunity to COVID-19.”

The Current Guidance Is Based on Studies of Other Vaccines

The guidance for the COVID-19 vaccine is based on studies of other vaccines, like the flu shot, and DMTs — not the COVID-19 products approved for use in the United States, from Pfizer-BioNTech and Moderna. Indeed, it’s unclear how many people with MS or those on DMTs were included in clinical trials of the two COVID-19 shots, even though all indications are they’re perfectly safe, Gluck says.

And, even a vaccine that's less effective because of DMT will offer more protection than no vaccine at all, according to the NMSS.

Importantly, you don’t need to take extra precautions when getting the COVID-19 vaccine, Gluck notes. You can receive the shot at any facility listed by your local department of health, as opposed to needing to go to a doctor’s office or hospital, she says.

“MS doctors, including myself, and the National Multiple Sclerosis Society are encouraging people with MS to get the COVID-19 vaccine once they are able to do so,” Gluck says.