Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement

Otero‐Romero, Susana; Rodríguez‐García, Juan; Vilella, Anna; Ara, J.R.; Brieva, Ll; Calles, Carmen; Carmona, Olga; Casanova, Verónica; Costa‐Frossard, Lucienne; Eichau, Sara; García-Merino, J.A.; García-Vidal, Carolina; González-Platas, Montserrat; Llaneza, M.; Martínez-Ginés, María Luisa; Meca-Lallana, José; Prieto, José M.; Rodríguez‐Antigüedad, Alfredo; Tintoré, Mar; Blanco, Yolanda; Moral, Esther

doi:10.1016/j.nrleng.2020.02.010

Cited by 12 publications

(20 citation statements)

References 60 publications

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“…Annual administration of the influenza vaccine to people with MS is an internationally and nationally recommended measure [ 2 , 3 , 4 , 5 ] because it is the main method of preventing flu and its severe complications [ 2 ]. The influenza vaccine is effective and safe in MS patients [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Influenza Vaccination Coverage among Multiple Sclerosis Patients: Evolution over Time and Associated Factors

Hernández-García

Garcés-Redondo²,

Rodríguez-Montolio³

et al. 2022

Vaccines

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Our objective was to determine the influenza vaccination rate in a Spanish cohort of multiple sclerosis (MS) patients. A retrospective cohort study was carried out. Patients who attended the MS unit of the Lozano Blesa Hospital of Zaragoza between January 2015 and 2020 were included. The variables were obtained by reviewing the specialized and primary care records. Associations between receiving the vaccine in each flu season and the other variables were analyzed using bivariate analysis and multiple logistic regression models. A total of 260 patients were studied, with a median age of 31 years at the time of diagnosis. A total of 62.3% (162/260) were women. Vaccination coverage ranged from 20.4% in the 2015–2016 and 2016–2017 seasons to 41.5% in the 2019–2020 season (p = 0.000). Having been vaccinated in the previous season (ORa: 16.47–390.22; p = 0.000) and receiving a vaccination recommendation from the hospital vaccination unit (ORa: 2.44–3.96; p < 0.009) were associated with being vaccinated. The coverage is in an intermediate position compared to other countries. It is necessary to improve the referral system of these patients to the hospital vaccination unit because the information obtained by this service contributed to higher vaccination rates.

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Section: Introductionmentioning

confidence: 99%

Influenza Vaccination Coverage among Multiple Sclerosis Patients: Evolution over Time and Associated Factors

Hernández-García

Garcés-Redondo²,

Rodríguez-Montolio³

et al. 2022

Vaccines

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“…Pregnant women with MS have the same vaccination indications as the general pregnant population (only live vaccines are contraindicated due to the theoretical risk to the fetus), and so should be vaccinated according to local recommendations. Inactivated influenza and the inactivated diphtheria, tetanus, and acellular pertussis (Tdap) are routinely offered to pregnant women with MS. 228 , 229 Preliminary findings have shown no obvious safety issues among pregnant women who received an mRNA Covid-19 vaccine, 230 and since pregnancy itself is associated with an increased risk of severe infection, mRNA Covid-19 vaccines should be recommended and may be administered at the same time as other vaccines routinely administered in pregnancy (eg, influenza, Tdap). A separation period between vaccinations is unnecessary, 231 although some authors recommend a 7- to 14-day gap between receiving a COVID-19 vaccine and the flu vaccine.…”

Section: Management Of Ms During Pregnancy ( Box 1 )mentioning

confidence: 99%

Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy

Villaverde-González¹

2022

DNND

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Multiple sclerosis (MS) is a chronic immune-mediated, inflammatory, and degenerative disease that is up to three times more frequent in young women. MS does not alter fertility and has no impact on fetal development, the course of pregnancy, or childbirth. The Pregnancy in Multiple Sclerosis Study in 1998 showed that pregnancy, mostly in untreated women, did not adversely affect MS, as disease activity decreased during pregnancy (although it significantly increased in the first trimester postpartum). These findings, together with the limited information available on the potential risks of fetal exposure to disease modifying treatments (DMTs), meant that women were advised to delay the onset of DMTs, stop them prior to conception, or, in case of unplanned pregnancy, discontinue them when pregnancy was confirmed. Now, many women with MS receive DMTs before pregnancy and, despite being considered a period of MS stability, up to 30% of patients could relapse in the first trimester postpartum. Factors associated with an increased risk of relapse and disability during pregnancy and postpartum include relapses before and during pregnancy, a greater disability at the time of conception, the occurrence of relapses after DMT cessation before conception, and the use of high-efficacy DMTs before conception, especially natalizumab or fingolimod. Strategies to prevent postpartum activity are needed in some patients, but consensus is lacking regarding the therapeutic strategies for women with MS of a fertile age. This, along with the increasing number of DMTs, means that the decision-making processes in aspects related to family planning and therapeutic strategies before, during, and after pregnancy are increasingly more complex. The purpose of this review is to provide an update on pregnancy-related issues in women with MS, including recommendations for counseling, general management, use of DMTs in pre-pregnancy, pregnancy, and postpartum periods, and breastfeeding-related aspects of DMTs.

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“…The Spanish demyelinating disease study group recommends administering vaccines included in the adult vaccination calendar and some specific vaccines, depending on the patient’s pre-existing immune status, before receiving immunosuppressive treatment to minimize risk of infection during treatment [ 32 ]. When immunosuppressive treatment has started, live attenuated vaccines are contraindicated.…”

Section: Consensus Recommendationsmentioning

confidence: 99%

“…a The CLARITY and CLARITY extension studies showed that the percentage of patients requiring a change in treatment due to the appearance of disease activity between year 1 and 2 was 2.5% and between year 3 and year 4 was 3.1% [5,8]. b Recent data from the CLASSIC-MS study showed that more than half of the patients (55.8%) who received cladribine in the CLARITY study remained free of additional treatment during a median follow-up of 10.9 years [14] The Spanish demyelinating disease study group recommends administering vaccines included in the adult vaccination calendar and some specific vaccines, depending on the patient's pre-existing immune status, before receiving immunosuppressive treatment to minimize risk of infection during treatment [32]. When immunosuppressive treatment has started, live attenuated vaccines are contraindicated.…”

Section: Cladribine Safety: Recommendations To Maximize the Safety Of...mentioning

confidence: 99%

“…However, there is evidence suggesting that the response to COVID-19 vaccines in patients taking cladribine is independent of lymphocyte count as well as B and T cell counts [42]. In stable patients who are about to start or receive a second course of cladribine, they advise waiting at least 3 weeks after the last dose of an inactivated COVID-19 vaccine to achieve the maximum possible immunity [32]. Cladribine is contraindicated in patients with an active malignancy.…”

Section: Cladribine Safety: Recommendations To Maximize the Safety Of...mentioning

confidence: 99%

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Expert-Agreed Practical Recommendations on the Use of Cladribine

et al. 2022

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Cladribine is a disease-modifying selective immune reconstitution oral therapy for adult patients with highly active relapsing multiple sclerosis (RMS). It was approved in the USA in 2019 and in Europe in 2017, thus there are still gaps in existing guidelines for using cladribine tablets in clinical practice. Nine experts with extensive experience in managing patients with multiple sclerosis in Spain identified some of the unanswered questions related to the real-life use of cladribine tablets. They reviewed the available clinical trial data and real-world evidence, including their own experiences of using cladribine, over the course of three virtual meetings held between November 2020 and January 2021. This article gathers their practical recommendations to aid treatment decision-making and optimise the use of cladribine tablets in patients with RMS. The consensus recommendations cover the following areas: candidate patient profiles, switching strategies (to and from cladribine), managing response to cladribine and safety considerations.

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Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement

Cited by 12 publications

References 60 publications

Influenza Vaccination Coverage among Multiple Sclerosis Patients: Evolution over Time and Associated Factors

Influenza Vaccination Coverage among Multiple Sclerosis Patients: Evolution over Time and Associated Factors

Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy

Expert-Agreed Practical Recommendations on the Use of Cladribine

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