Immunization and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society

Lebrun, C.; Vukusic, Sandra; Abadie, Valérie; Achour, C.; Ader, Florence; Alchaar, H.; Abdullatif, Alkhedr; Andreux, F.; Androdias, Géraldine; Arjmand, Reza; Audoin, Bertrand; Audry, Dominique; Aufauvre, D.; Autreaux, C.; Ayrignac, Xavier; Bailbé, M.; Benazet, M.; Bensa, Caroline; Bensmaïl, Djamel; Berger, E.; Bernady, Patricia; Bertagna, Y.; Biotti, Damien; Blanchard-Dauphin, A.; Bonenfant, Julien; Bonnan, Mickaël; Bonnemain, Bruno; Borgel, F.; Botelho-Nevers, E; Boucly, S.; Bourre, Bertrand; Boutière, Clémence; Branger, Pierre; Brassat, David; Bresch, Saskia; Breuil, V.; Brochet, Bruno; Brugeilles, H.; Bugnon, Pierre; Cabre, Philippe; Camdessanché, Jean‐Philippe; Carra-Dalière, C.; Casez, Olivier; Chamouard, Jean Marie; Chassande, B.; Chataignier, P.; Chbicheb, Mohamed; Chenet, A.; Ciron, Jonathan; Clavelou, Pierre; Cohen, M.; Colamarino, R.; Collongues, Nicolas; Coman, Irène; Corail, Patrick René; Courtois, Sophie; Coustans, M.; Créange, Alain; Creisson, E.; Daluzeau, Nathalie; Davenas, C.; Sèze, Jérôme De; Debouverie, M.; Depaz, Raphaël; Derache, Nathalie; Divio, L.; Douay, X.; Dulau, Cécile; Durand‐Dubief, Françoise; Edan, Gilles; Elias, Zyad; Fagniez, Ombeline; Faucher, Marion; Faucheux, Jean Marc; Fournier, Mario; Gagneux‐Brunon, Amandine; Gaida, P; Galli, P.; Gallien, P.; Gaudelus, J.; Gault, D. E.; Gayou, Annick; Genevray, M.; Gentil, Almir Adir; Gere, Judith; Gignoux, Laurence; Giroux, Michel; Givron, P.; Gout, Olivier; Grimaud, J; Guennoc, Anne‐Marie; Hadhoum, Nawal; Hautecœur, Patrick; Heinzlef, Olivier; Jaeger, Martin; Jeannin, Sophie; Kremer, Laurent; Kwiatkowski, Arnaud; Labauge, Pierre; Labeyrie, Céline; Lachaud, Sylvain; Laffont, I.; Lanctin-Garcia, C.; Lannoy, Julien; Lanotte, Livia; Laplaud, David‐Axel; Latombe, Dominique; Lauxerois, M.; Page, Emmanuelle Le; Lebrun-Frénay, Christine; Lejeune, P.; Lejoyeux, P.; Lemonnier, B.; Leray, Emmanuelle; Loche, C.-M.; Louapre, Céline; Lubetzki, Catherine; Maarouf, Adil; Mada, B.; Magy, Laurent; Maillart, E.; Manchon, Éric; Marignier, Romaine; Marque, P.; Mathey, Guillaume; Maurousset, Aude; Mékiès, Claude; Merienne, M; Lévêque, Michel; Milor, A.-M.; Moisset, Xavier; Montcuquet, Alexis; Moreau, Thibault; Morel, Nathalie; Moussa, Mahaman; Naudillon, J.-P.; Normand, M; Olive, Philippa; Ouallet, J.-C.; Outteryck, Olivier; Pacault, C.; Papeix, Caroline; Patry, I.; Peaureaux, D.; Pelletier, Jean; Pichon, Bruno; Pittion, Sophie; Planque, Evelyne; Pouget, M.C.; Pourcher, Valérie; Radot, Caroline; Robert, Isabelle; Rocher, Fanny; Ruet, A.; Saint-Val, C.; Salle, Jean-Yves; Salmon, Andrew; Sartori, Enrico; Schaeffer, S.; Stankhof, B.; Taithe, F.; Thouvenot, Éric; Tizon, C.; Tourbah, Ayman; Tourniaire, P.; Vaillant, Mathieu; Vermersch, Patrick; Vidil, S.; Wahab, Abdul; Warter, M.-H.; Wiertlewski, Sandrine; Wiplosz, B.; Wittwer, B; Zaenker, C.; Zephir, Hélène

doi:10.1016/j.neurol.2019.04.001

Cited by 20 publications

(14 citation statements)

References 54 publications

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“…( Rubin et al., 2013 ) It is generally recommended to avoid administering live vaccines during treatment with and until at least 4 weeks after discontinuing high-dose corticosteroids. ( Lebrun and Vukusic, 2019 ; Rubin et al., 2013 )…”

Section: Discussionmentioning

confidence: 99%

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Effects of MS disease-modifying therapies on responses to vaccinations: A review.

Ciotti

Valtcheva

Cross

2020

Multiple Sclerosis and Related Disorders

116

160

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Background : Development of long-term immunologic memory relies upon humoral and cellular immune responses. Vaccinations aim to stimulate these responses against pathogens. Several studies have evaluated the impact of multiple sclerosis disease-modifying therapies on immune response to vaccines. Findings from these studies have important implications for people with multiple sclerosis who require vaccination and are using disease-modifying therapies. Methods : Searches using PubMed and other engines were conducted in May 2020 to collect studies evaluating the impact of various disease-modifying therapies on immune responses to vaccination. Results : Several studies demonstrated preserved immune responses in people treated with beta-interferons to multiple vaccine types. Limited data suggest vaccine responses to be preserved with dimethyl fumarate treatment, as well. Vaccine responses were reduced to varying degrees in those treated with glatiramer acetate, teriflunomide, sphingosine-1-phosphate receptor modulators, and natalizumab. The timing of vaccination played an important role in those treated with alemtuzumab. Humoral vaccine responses were significantly impaired by B cell depleting anti-CD20 monoclonal antibody therapies, particularly to a neoantigen. Data are lacking on vaccine responses in patients with multiple sclerosis taking cladribine and high-dose corticosteroids. Notably, the majority of these studies have focused on humoral responses, with few examining cellular immune responses to vaccination. Conclusions : Prior investigations into the effects of individual disease-modifying therapies on immune responses to existing vaccines can serve as a guide to expected responses to a SARS-CoV-2 vaccine. Responses to any vaccination depend on the vaccine type, the type of response (recall versus response to a novel antigen), and the impact of the individual disease-modifying therapy on humoral and cellular immunity in response to that vaccine type. When considering a given therapy, clinicians should weigh its efficacy against MS for the individual patient versus potential impact on responses to vaccinations that may be needed in the future.

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Section: Discussionmentioning

confidence: 99%

“…( Moriabadi et al., 2001 ) Regulatory bodies now recommend vaccinating people with MS on a normal schedule, with some caveats regarding live attenuated vaccines. ( 14 ; Lebrun and Vukusic, 2019 ; Epstein et al., 2018 )…”

Section: Introductionmentioning

confidence: 99%

Effects of MS disease-modifying therapies on responses to vaccinations: A review.

Ciotti

Valtcheva

Cross

2020

Multiple Sclerosis and Related Disorders

116

160

View full text Add to dashboard Cite

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“…Despite previously claimed deleterious effect of vaccination in pwMS, vaccines do not appear to be associated with an increased risk of developing MS, having a first clinical demyelinating event or to be related to a higher risk of relapse. However, there is still some reluctance among patients and doctors when it comes to vaccination in MS ( Farez et al, 2019 ; Lebrun and Vukusic, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Opinions, beliefs and knowledge of people with multiple sclerosis on COVID-19 pandemic and vaccine

Dionísio

Santos

Rodrigues

et al. 2021

Multiple Sclerosis and Related Disorders

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BACKGROUND Considering the potential COVID-19 impact on pwMS health and the importance of vaccination for this population, we decided to assess: (a) pwMS’ beliefs and knowledge on COVID-19 pandemic; (b) their acceptance towards COVID-19 vaccination and (c) pwMS’ opinions on general vaccination. METHODS Observational study, based on a cross-sectional (10-20 th September 2020) online survey, conducted in a cohort of pwMS’ followed at two Portuguese hospitals. The survey included measures to characterize the sample and a questionnaire designed to assess the topics defined for this study. RESULTS 270 respondents completed the full survey (response rate 58.2%). pwMS greatest concern during the pandemic was an aggravation of MS, especially by patients older than 50 years old. Almost 40% of the patients older than 50 felt that the pandemic negatively affected their MS related medical assistance. Most patients believed they would recover from COVID-19 infection. More than half of the responders feared a MS aggravation if they got COVID-19; this was more pronounced in patients with progressive MS. About 12% of the participants did not want to be vaccinated and almost 40% was unsure. Regarding vaccines in general, almost a third of the participants feared their side effects or MS related complications. CONCLUSION Having knowledge of pwMS’ opinions on COVID-19 pandemic impact and vaccination is useful to better address these issues. Fears and expectations towards vaccination must be discussed with pwMS.

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“…This has led international guidelines to advise against the administration of the MMR vaccine in all patients treated with immunosuppressive therapies including the new biotherapies for MS due to fears of vaccine-associated disease [ 5 , 6 , 31 ]. More specifically, French [ 4 ] and Canadian [ 3 ] recommendations argue that despite no supporting data, patients treated by natalizumab should be considered as immunocompromised and thus not be vaccinated with MMR. Yet a retrospective study of 116 patients on immunosuppressive therapy (including one patient on natalizumab treatment) matched with a healthy control group found no difference in local and systemic reactions after receiving a live attenuated vaccine [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Emergence of increasingly diverse immunosuppressive treatments, whose immunologic effect is not always clear, challenges this general contraindication. At present, little data exists on the safety of live-attenuated vaccines in those patients, and recommendations are based on expert opinion that may differ [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Vaccine-associated measles in a patient treated with natalizumab: a case report

et al. 2020

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Background Safety of live vaccines in patients treated with immunosuppressive therapies is not well known, resulting in contradictory vaccination recommendations. We describe here the first case of vaccine-associated measles in a patient on natalizumab treatment. Case presentation A young female patient with relapsing-remitting multiple sclerosis on natalizumab treatment received the live attenuated measles, mumps, and rubella vaccine in preparation for a change in her treatment in favour of fingolimod, with established immunosuppressive qualities. Seven days after receiving the vaccine, our patient experienced diffuse muscle pain, fatigue, and thereafter developed a fever and then an erythematous maculopapular rash, compatible with vaccine associated measles. This was later confirmed by a positive measles RT-PCR throat swab. The patient’s symptoms resolved without any sequelae. Conclusion In this case report we review the immunosuppressive qualities of natalizumab and the evidence in favour and against live vaccines in patients on this treatment. Our findings reveal the insufficient understanding of the immunosuppressive effects of new immunomodulators, and thus of the safety of live vaccines in patients on such medications. While this case triggers precaution, there is insufficient evidence to conclude that natalizumab treatment could favor the onset of vaccine-associated measles.

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Immunization and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society

Cited by 20 publications

References 54 publications

Effects of MS disease-modifying therapies on responses to vaccinations: A review.

Effects of MS disease-modifying therapies on responses to vaccinations: A review.

Opinions, beliefs and knowledge of people with multiple sclerosis on COVID-19 pandemic and vaccine

Vaccine-associated measles in a patient treated with natalizumab: a case report

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