This information is current as of 03-January-2022
For additional information on the COVID-19 virus and the impact on patient with MS, click here.
Updates on omicron and monoclonal antibodies for pre-exposure prophylaxis
The new COVID-19 variant has recently been identified in the Massachusetts. People with Omicron infection can spread the virus even if vaccinated, so we recommend continued mask wearing and social distancing. There have been breakthrough infections among the vaccinated. There is emerging data that three doses of mRNA vaccine are effective at neutralizing omicron in the laboratory. Therefore, we recommend that all of our patients get a third dose of vaccine if eligible, as well as a booster (LINK TO CDC TABLE ON OUR WEBSITE, https://brighammscenter.org/patient-information/covid-19-vaccine-information/)
- Monoclonal antibodies for pre-exposure prophylaxis (Evusheld)
The FDA has issued an emergency use authorization for AstraZeneca’s Evusheld, which is a monoclonal antibody indicated for pre-exposure prophylaxis of COVID-19 in individuals who are moderately or severely immunocompromised and may not mount an adequate immune response to COVID-19 vaccination.
More information about the medication is available at the following link: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-new-long-acting-monoclonal-antibodies-pre-exposure
Where can I get Evusheld? No drug supply has been distributed yet, but we expect supply will be extremely limited. Once we have more information about supply we will reach out to eligible patients.
Can I get Evusheld if I’ve been exposed or have COVID-19? This treatment is not authorized for COVID-19 treatment or for prevention of infection if you’ve been exposed (link information below on post-exposure prophylaxis).
Does Evusheld work against the Omicron variant? This is an area of active investigation.
- For more information about monoclonal antibodies for post-exposure prophylaxis and treatment of patients with COVID-19 (Regen-COV) (link https://brighammscenter.org/patient-information/covid-19/)
Updates regarding third dose vaccines, boosters, and the Delta variant:
- Third Dose/Booster vaccine (for patients who are on a disease modifying therapy)
On August 12th, 2021 the FDA approved the use of a third dose vaccine, or additional dose of either the Pfizer of Moderna COVID-19 vaccine in immunocompromised individuals. This was based on a study in organ transplant recipients, not in MS patients. Though we do not know exactly how a third dose will impact MS patients at this time, we are recommending a third dose for those patients with MS on disease modifying therapies. In addition, preliminary data has shown that antibody titer levels are higher with the Moderna vaccine vs the Pfizer vaccine, so if possible, we would recommend a third dose with the Moderna vaccine.
Where can I get a third dose? You can schedule a third dose via https://vaxfinder.mass.gov/ or through your local pharmacy. You do NOT need a doctor’s note to get another dose.
When should I get a third dose? CDC guidance is to wait at least 28 days after your second vaccine dose before obtaining a third shot.
What if I received the Johnson & Johnson vaccine? It is recommended to get an additional shot 2 months after the first Johnson & Johnson vaccine. The CDC has approved a “mix and match” approach, so you may choose which vaccine you receive as a booster. If possible we recommend either the Pfizer or Moderna vaccine.
What if I am not on immunotherapy? The CDC has now approved booster vaccines for the following groups:
- If you received Pfizer or Moderna you are eligible for a booster vaccine 6 months from your second dose:
- If you received the Johnson & Johnson vaccine:
- As above, anyone 18 and older is elgible for a booster 2 months after your first shot.
>>> More information is available at this link: Considerations for use of a COVID-19 vaccine booster dose
- The Delta variant
COVID-19 vaccines are safe and effective at preventing severe disease and death from the Delta variant, however, increasing number of infections have been reported in vaccinated people with the Delta variant. Even if you are fully vaccinated and are infected with the Delta variant, you can still spread the virus to others. Thus, we strongly recommend that our patients social distance and continue to wear masks as much as possible. Because of the rise of the Delta variant, as of July 30, the Massachusetts Department of Public Health recommends that individuals wear a mask indoors in public regardless of vaccination status if they are immunocompromised or at increased risk of severe disease, or who have a household member who is immunocompromised or at increased risk of severe disease or is an unvaccinated adult.
Updates regarding increased risk due to medical conditions:
On May 15, 2021, Center for Disease Control and Prevention (CDC) issued guidance on medical conditions that may increase the risk of severe illness from COVID 19. These conditions include cancer, chronic kidney disease, chronic lung disease, dementia, diabetes, heart disease, HIV/AIDs, stroke, history of organ transplantation, pregnancy, substance use disorder and smoking, liver disease, obesity and pregnancy. Certain illnesses that cause immunosuppressed state are also included.
MS is NOT included in a list of conditions that increase the risk of severe COVID 19.
We recommend vaccination against COVID-19 to our patients. Vaccination is also recommended by the National MS Society.
However, the CDC has stated that “People with weakened immune systems should also be aware of the potential for reduced immune responses to the vaccine, as well as the need to continue following current guidance to protect themselves against COVID-19.” Additional information about underlying conditions can be found here.
Information about COVID vaccine efficacy on specific MS treatments is forthcoming. Available data and prior studies evaluating other vaccine efficacy on specific MS treatments is listed in the section below.
General information on the COVID-19 vaccines:
The currently approved vaccines are mRNA vaccines produced by Pfizer and Moderna, and a modified adenovirus vector virus vaccine produced by Johnson and Johnson. We do not know which vaccine you will receive. This will depend on where you live, your insurance, and other distribution factors. The Pfizer vaccine requires two doses separated by 3 weeks, the Moderna vaccine requires two doses separated by 4 weeks, and the Johnson and Johnson vaccine is a single dose vaccine.
In April 2021, distribution of the Johnson and Johnson vaccine was briefly put on hold while the CDC and FDA reviewed an extremely rare side effect of cerebral venous sinus thrombosis (a blood clot in one of the veins in the brain) associated with low platelets. However, given the rarity of this side effect when balanced with the benefits of the vaccine, distribution of the Johnson and Johnson vaccine has now resumed.
Please contact your primary care provider immediately if you develop any of the following symptoms within one month of receiving the Johnson and Johnson vaccine.
- Headache that is constant, worse with positional changes (bending over), or associated with nausea, vomiting, or vision changes
- Headache that resolved within 24 hours of vaccine administration but then recurred
- Abdominal pain, leg swelling (bilateral or unilateral), chest pain, shortness of breath, or bruising/petechiae
When should I get the vaccines? Who should get the vaccines?
- In general, we recommend that our patients follow the vaccination program guidelines developed by the Massachusetts department of public health. https://www.mass.gov/info-details/massachusetts-covid-19-vaccine-information
- If you have MS and are in a high risk profession or have high risk exposures (i.e. health care workers, EMTs, police officers, other essential worker etc…) we would recommend you be vaccinated when it becomes available to you.
- If you are on rituximab, or ocrelizumab if possible, we would recommend getting vaccinated at least 3 months or longer after your infusion, and waiting at least 4 weeks after getting fully vaccinated before your next infusion to maximize the effectiveness. You are considered fully vaccinated after having the second dose of the Pfizer or Moderna vaccines, or one dose of the Johnson and Johnson vaccine. However, if this timing is not possible, then we recommend getting vaccinated whenever feasible.
- After receiving rituximab or ocrelizumab your B cells are suppressed. B cells are a type of white blood cell important to mounting vaccine responses and providing immunity. As the rituximab or ocrelizumab wears off and your B cells start to come back, you may be more likely to mount a response to the vaccine. However, we also know that patients on B cell therapies who get COVID may be more severely affected, so the decision and timing of vaccination should be a risk/benefit discussion with your neurologist.
- If you have had vaccine related adverse reactions, or allergic reactions please consult your primary care provider prior to getting vaccinated.
- If you have new or worsening neurologic symptoms in the days or weeks after receiving vaccination, please, consult your neurologist.
Are the vaccines safe for patients with MS?
The vaccines were not tested in patients with MS or with other autoimmune diseases therefore we do not have information about safety specifically in MS patients. However, inactivated vaccines such as the flu, shingles, and pneumonia vaccines are generally safe and recommended in patients with MS. The COVID-19 vaccines in the general population were found to be safe. The most common adverse effects were local pain, redness, and swelling at injection sites, as well as transient fatigue, muscle pains, joint pains, chills, or fevers.
- Detailed safety information for the Pfizer vaccine
- Detailed safety information for the Moderna vaccine
- Detailed safety information for the Johnson and Johnson vaccine
Are the vaccines effective for patients with MS?
The COVID-19 vaccines were not tested in patients with MS or with other autoimmune diseases. We believe that having MS will not negatively impact the efficacy of the vaccines; however, receiving some disease modifying treatments might impact overall vaccine efficacy and durability. This is an area of ongoing research. There is more information below based on what we know so far about the effectiveness of the COVID-19 vaccine and other (non-COVID-19) vaccines in MS patients on disease modifying therapies.
Will the vaccines worsen my MS?
We do not have this information specifically for the COVID vaccines. However, results of large trials have shown that other vaccines do not cause MS, worsen MS, or cause relapses 10,11. It is important to note that fever can exacerbate preexisting MS symptoms but should not cause new symptoms. Please reach out to your doctor if you have persistent symptoms or new symptoms associated with the COVID vaccination.
Where can I get the vaccines?
COVID vaccines will NOT be distributed at the Brigham MS center. Mass General Brigham is vaccinating patients on a limited basis via lottery depending on eligibility. You will be contacted via patient gateway if you are eligible to schedule a vaccine at Mass General Brigham. We encourage you to schedule a vaccine at other vaccination sites in the state. To determine if you are currently eligible to receive a vaccine and to schedule a vaccine, please visit this website.
Who can get the vaccine?
People ages 12 and older who live, work, or study in Massachusetts can get vaccinated against COVID-19. People ages 12-17 can only get the Pfizer vaccine. People age 18 and older can get any vaccine. The vaccine is safe and effective. You don’t need an ID or insurance to get it.
Please visit this website for Governor Baker’s Massachusetts vaccine plan for more information.
Table 1: Vaccine efficacy studies in patients on MS disease modifying treatments
|Medication||Vaccine effectiveness when compared to patients not on disease modifying therapy||Further details and references|
|Copaxone (glatiramer acetate)||As effective||Patients on Copaxone receiving the flu vaccine had similar responses to healthy controls.1|
|Avonex, Betaseron, Plegridy, Rebif (interferons)||As effective||Patients on interferon beta-1a 44mcg three times weekly had no difference in their ability to mount an immune response to the flu vaccine compared to controls.2|
|Aubagio (teriflunomide)||As effective||Patients on Aubagio had similar responses to the flu vaccine compared to those on interferons.3|
|Tecfidera (dimethyl fumarate)
Vumerity (diroxel fumarate)
|As effective||Patients on Tecfidera mounted similar immune responses to pneumococcus, meningococcus and tetanus vaccines as those on interferons.4|
|Possibly less effective||Most patients on Gilenya were able to mount immune responses to the flu vaccine but response rates were less than patients not on Gilenya.5 Patients on Siponimod also had lower response rates to the flu vaccine compared to controls.6 Emerging evidence suggests that patients on these treatments may not be able to mount a full response against COVID19 after receiving a complete series of vaccinations.7,8
|Tysabri (natalizumab)||Possibly less effective||A lower proportion of patients on Tysabri responded to tetanus vaccines compared to controls though this was not a statistically significant difference.9 Smaller studies have shown that fewer patients on Tysabri responded to the H1N1 vaccine10 and flu vaccine1 compared to controls.|
|Possibly less effective||A study on tetanus, pneumococcus, and flu vaccines showed that those on Ocrevus did mount immune responses to all three vaccines, but to a lesser degree than patients not on disease modifying therapy or on interferons. Emerging evidence suggests that patients on these treatments may not be able to mount a strong response against COVID19 after receiving a complete series of vaccinations.
|Mavenclad (cladribine)||Unknown||Two recent studies suggest that patients on Mavenclad mount successful immune response to common vaccinations:
MAGNIFY-MS study show protective antibody levels for at least six months following seasonal influenza and varicella zoster vaccines, irrespective of vaccine timing relative to cladribine dosing. Initial findings from the CLOCK-MS vaccine sub-study show protective influenza antibody levels at four weeks post-vaccination in MS patients taking Cladribine.
In both studies, protective antibody levels were maintained or increased independent of lymphocyte counts.
*No data is available for Vumerity, Zeposia or Kesimpta, but these medications are grouped with those disease modifying therapies of similar classes.