Disease-modifying therapies and SARS-CoV-2 vaccination in multiple sclerosis: an expert consensus

Centonze, Diego; Rocca, Maria; Gasperini, Claudio; Kappos, Ludwig; Hartung, Hans Peter; Magyari, Melinda; Oreja‐Guevara, Celia; Trojano, María; Wiendl, Heinz; Filippi, Massimo

doi:10.1007/s00415-021-10545-2

Cited by 50 publications

(60 citation statements)

References 78 publications

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“…Following the approval of COVID-19 vaccines across EU countries, vaccination programmes have been started in order to identify vulnerable people at highest risk from serious illness or death from COVID-19. According to recent recommendations from the Italian Ministry of Health and an Italian expert consensus, people with Multiple Sclerosis (MS), especially those with disabilities, progressive forms of the disease, older age, and comorbidities, were considered to be the category with the highest priority during the second phase of the Italian immunization programme (1,2).…”

Section: Introductionmentioning

confidence: 99%

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

et al. 2021

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We describe a case of acute relapse in a woman with Multiple Sclerosis (MS) shortly after the mRNA COVID-19 vaccination. The patient received a diagnosis of MS in November 2016 at the MS Centre of the A. Cardarelli Hospital (South of Italy). Since that moment, her clinical conditions and pharmacological therapies have been managed at this MS centre where, according to national recommendations, in April 2021, the patient received the BNT162b2 vaccine. Almost 48 h after receiving the vaccine, the patient developed paraesthesia and weakness in her left arm and limbs. The neurological examination revealed walking difficulties while the MRI showed three new voluminous enhancing lesions. After having received methylprednisolone iv for 5 days, the patient's neurological symptoms fully recovered. Along with the implementation of COVID-19 vaccination programmes among vulnerable population, further studies are needed in order to improve our knowledge on the benefit/risk ratio of COVID-19 vaccines.

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Section: Introductionmentioning

confidence: 99%

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

et al. 2021

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“…For non-live/inactivated vaccines, such as seasonal influenza vaccines, it is recommended to vaccinate patients treated with ocrelizumab since a protective humoral response can be expected, even if attenuated [ 60 ]. An expert consensus recently suggested that patients planned to receive ocrelizumab should be vaccinated at least 6 weeks before the first administration, whereas in those already receiving ocrelizumab, vaccinations should be administered at least 3 months after the last infusion [ 61 ].…”

Section: Safety and Tolerability Of Anti-cd20 Therapiesmentioning

confidence: 99%

Anti-CD20 therapies for multiple sclerosis: current status and future perspectives

et al. 2021

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Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease affecting the central nervous system (CNS), often characterized by the accumulation of irreversible clinical disability over time. During last years, there has been a dramatic evolution in several key concepts of immune pathophysiology of MS and in the treatment of this disease. The demonstration of the strong efficacy and good safety profile of selective B-cell-depleting therapies (such as anti-CD20 monoclonal antibodies) has significantly expanded the therapeutic scenario for both relapsing and progressive MS patients with the identification of a new therapeutic target. The key role of B cells in triggering MS disease has been also pointed out, determining a shift from the traditional view of MS activity as largely being ‘T-cell mediated’ to the notion that MS-related pathological processes involve bi-directional interactions between several immune cell types, including B cells, both in the periphery and in the CNS. This review provides an updated overview of the involvement of B cells in the immune pathophysiology and pathology of MS. We summarize the rationale regarding the use of anti-CD20 therapies and the results of the main randomized controlled trials and observational studies investigating the efficacy and safety profile of rituximab, ocrelizumab, ofatumumab and ublituximab. Suggestions regarding vaccinations and management of MS patients during COVID-19 pandemic with anti-CD20 therapies are also discussed. Finally, therapies under investigation and future perspectives of anti-CD20 therapies are taken into consideration.

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“…• Cladribine is a purine analog which causes lymphocyte depletion by interfering with DNA synthesis, repair and cell metabolism. For cladribine, no conclusive data on vaccination are available yet, but multiple studies are currently being conducted (48,66). • Ocrelizumab, rituximab, and ofatumumab are anti-CD20 monoclonal antibodies leading to depletion of B cells in the circulation.…”

Section: Vaccination Is Protective Yet Partly Less Effective Under Certain Dmtmentioning

confidence: 99%

“…In this regard, monthly administered subcutaneous human B cell-depleting agent ofatumumab may offer the advantage of a shorter time span until CD19+ B cell repletion takes place (74). For ocrelizumab treatment, it is often suggested to vaccinate patients at the end of a treatment cycle with a minimum distance of four to six weeks to the next cycle (66,75). However, these experientially suggested time points need further confirmation in clinical studies.…”

Section: Vaccination Is Protective Yet Partly Less Effective Under Certain Dmtmentioning

confidence: 99%

Approach to SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis

et al. 2021

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For more than a year now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been causing the coronavirus disease (COVID-19) pandemic with high mortality and detrimental effects on society, economy, and individual lives. Great hopes are being placed on vaccination as one of the most potent escape strategies from the pandemic and multiple vaccines are already in clinical use. However, there is still a lot of insecurity about the safety and efficacy of vaccines in patients with autoimmune diseases like multiple sclerosis (MS), especially under treatment with immunomodulatory or immunosuppressive drugs. We propose strategic approaches to SARS-CoV-2 vaccination management in MS patients and encourage fellow physicians to measure the immune response in their patients. Notably, both humoral and cellular responses should be considered since the immunological equivalent for protection from SARS-CoV-2 after infection or vaccination still remains undefined and will most likely involve antiviral cellular immunity. It is important to gain insights into the vaccine response of immunocompromised patients in order to be able to deduce sensible strategies for vaccination in the future.

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Disease-modifying therapies and SARS-CoV-2 vaccination in multiple sclerosis: an expert consensus

Cited by 50 publications

References 78 publications

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

Anti-CD20 therapies for multiple sclerosis: current status and future perspectives

Approach to SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis

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