ECTRIMS/EAN consensus on vaccination in people with multiple sclerosis: Improving immunization strategies in the era of highly active immunotherapeutic drugs

Abstract

Background: With the new highly active drugs available for people with multiple sclerosis (pwMS), vaccination becomes an essential part of the risk management strategy Objective: To develop a European evidence-based consensus for the vaccination strategy of pwMS who are candidates for disease-modifying therapies (DMTs). Methods: This work was conducted by a multidisciplinary working group using formal consensus methodology. Clinical questions (defined as population, interventions, and outcomes) considered all authorized DMTs and vaccines. A systematic literature search was conducted and quality of evidence was defined according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The recommendations were formulated based on the quality of evidence and the risk–benefit balance. Results: Seven questions, encompassing vaccine safety, vaccine effectiveness, global vaccination strategy and vaccination in sub-populations (pediatric, pregnant women, elderly and international travelers) were considered. A narrative description of the evidence considering published studies, guidelines, and position statements is presented. A total of 53 recommendations were agreed by the working group after three rounds of consensus. Conclusion: This first European consensus on vaccination in pwMS proposes the best vaccination strategy according to current evidence and expert knowledge, with the goal of homogenizing the immunization practices in pwMS.

Vaccine Safety and Immunogenicity in Patients With Multiple Sclerosis Treated With Natalizumab

“…In our study, a substantial proportion of patients who transitioned to anti-CD20 received the HBV vaccine, ensuring excellent seroprotection before the initiation of anti-CD20 therapy. The HAV vaccine, on the other hand, is strongly recommended for PWMS, especially international travelers who are seronegative, because hepatitis A in adults is a serious liver disease . Considering the excellent seroprotection rate and postvaccination IgG titers observed in our study, natalizumab may serve as a valuable therapeutic strategy to strike the right balance between providing early, highly effective treatment and achieving optimal immunization.…”

“…The HAV vaccine, on the other hand, is strongly recommended for PWMS, especially international travelers who are seronegative, because hepatitis A in adults is a serious liver disease. 24,48,50 Considering the excellent seroprotection rate and postvaccination IgG titers observed in our study, natalizumab may serve as a valuable therapeutic strategy to strike the right balance between providing early, highly effective treatment and achieving optimal immunization. This phenomenon could be attributed to the natalizumab antitraffic mechanism, which differs from the cell depletion observed in other agents.…”

“…Starting in 2015, PWMS at Cemcat were routinely referred to the preventive medicine department at Vall d’Hebron University Hospital for a baseline serostatus evaluation and immunization as per current guidelines . Postvaccination serological tests were consistently carried out within 1 to 3 months after vaccination.…”

Infektionen und Multiple Sklerose

“…In [143,144]. Dabei sollten sich MS-Patienten aufgrund der negativen Einflüsse von Infektionen auf die Mortalität, das Schubrisiko und möglicherweise auch die Behinderungsprogression entsprechend den aktuellen RKI-Empfehlungen für Erwachsene und Risikogruppen nach Möglichkeit impfen lassen [145].…”

“…adäquat leitliniengerecht behandelt werden. Zu den Impfungen von MS-Patienten gibt es verschiedene, teils nicht unkommentiert gebliebene Strategien 143 , 144 . Dabei sollten sich MS-Patienten aufgrund der negativen Einflüsse von Infektionen auf die Mortalität, das Schubrisiko und möglicherweise auch die Behinderungsprogression entsprechend den aktuellen RKI-Empfehlungen für Erwachsene und Risikogruppen nach Möglichkeit impfen lassen 145 .…”