• This record comes from PubMed

Summary of Safety and Efficacy of COVID Vaccination in Patients with Multiple Sclerosis

. 2023 ; 86 (4) : 263-276. [epub] 20230304

Language English Country Switzerland Media print-electronic

Document type Journal Article, Review

BACKGROUND: The SARS-CoV-2 pandemic represents one of the most challenging issues that have recently influenced everyday life in countries all over the world. Understanding the risk of this disease is of high importance in patients with multiple sclerosis (MS) as they represent a vulnerable population through their treatment with disease-modifying therapies (DMTs). Infective episodes may trigger relapses and lead to deterioration of the health condition. SUMMARY: Vaccination is an important preventive measure against infectious diseases. In MS patients, concerns have been raised about the effectiveness of vaccines in patients on various immunomodulatory drugs and about their possible adverse effects including impairment of neurological functions. The objectives of this article were to summarize the current knowledge on immune responses to the COVID-19 vaccines and their safety in MS patients and to provide practical guidance based on the data available to date. KEY MESSAGES: Although MS is not associated with a higher risk of COVID-19, this infection can trigger relapses or pseudo-relapses. Vaccines against SARS-CoV-2 are recommended for all MS patients who are not in the active phase of the disease, despite the fact that there is still a lack of long-term reliable data on the effectiveness and safety of vaccines against COVID-19. Some DMTs can reduce vaccine humoral responses, but might still provide some protection and adequate T-cell response. To optimize the effectiveness of vaccination, the ideal timing of vaccine application and DMTs dosing regimen is crucial.

See more in PubMed

Immovilli P, Morelli N, Terracciano C, Rota E, Marchesi E, Vollaro S, et al. . Multiple sclerosis treatment in the COVID-19 era: a risk-benefit approach. Neurol Int. 2022 Apr 15;14(2):368–77. 10.3390/neurolint14020030. PubMed DOI PMC

Beard K, Sriwastava S. Insight in booster COVID-19 vaccine and disease modifying therapy in multiple sclerosis. J Neurol Sci. 2021 Nov 15;430:120034. 10.1016/j.jns.2021.120034. PubMed DOI PMC

Coyle PK, Gocke A, Vignos M, Newsome SD. Vaccine considerations for multiple sclerosis in the COVID-19 era. Adv Ther. 2021 Jul;38(7):3550–88. 10.1007/s12325-021-01761-3. PubMed DOI PMC

Witman Tsur S, Adrian Zaher E, Tsur M, Kania K, Kalinowska-Łyszczarz A. Current immunological and clinical perspective on vaccinations in multiple sclerosis patients: are they safe after all? Int J Mol Sci. 2021 Apr 8;22(8):3859. 10.3390/ijms22083859. PubMed DOI PMC

Kelly H, Sokola B, Abboud H. Safety and efficacy of COVID-19 vaccines in multiple sclerosis patients. J Neuroimmunol. 2021 Jul 15;356:577599. 10.1016/j.jneuroim.2021.577599. PubMed DOI PMC

Landtblom AM, Berntsson SG, Boström I, Iacobaeus E. Multiple sclerosis and COVID-19: the Swedish experience. Acta Neurol Scand. 2021 Sep;144(3):229–35. 10.1111/ane.13453. PubMed DOI PMC

Cabreira V, Abreu P, Soares-Dos-Reis R, Guimarães J, Sá MJ. Multiple sclerosis, disease-modifying therapies and COVID-19: a systematic review on immune response and vaccination recommendations. Vaccines. 2021 Jul 11;9(7):773. 10.3390/vaccines9070773. PubMed DOI PMC

Sharifian-Dorche M, Sahraian MA, Fadda G, Osherov M, Sharifian-Dorche A, Karaminia M, et al. . COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: a systematic review. Mult Scler Relat Disord. 2021 May;50:102800. 10.1016/j.msard.2021.102800. PubMed DOI PMC

Toscano S, Chisari CG, Patti F. Multiple sclerosis, COVID-19 and vaccines: making the point. Neurol Ther. 2021 Dec;10(2):627–49. 10.1007/s40120-021-00288-7. PubMed DOI PMC

Smith TE, Kister I. Infection mitigation strategies for multiple sclerosis patients on oral and monoclonal disease-modifying therapies. Curr Neurol Neurosci Rep. 2021 May 19;21(7):36. 10.1007/s11910-021-01117-y. PubMed DOI PMC

Iannetta M, Landi D, Cola G, Campogiani L, Malagnino V, Teti E, et al. . B- and T-cell responses after SARS-CoV-2 vaccination in patients with multiple sclerosis receiving disease modifying therapies: immunological patterns and clinical implications. Front Immunol. 2022 Jan 17;12:796482. 10.3389/fimmu.2021.796482. PubMed DOI PMC

Inshasi J, Alroughani R, Al-Asmi A, Alkhaboury J, Alsalti A, Boshra A, et al. . Expert consensus and narrative review on the management of multiple sclerosis in the arabian gulf in the COVID-19 era: focus on disease-modifying therapies and vaccination against COVID-19. Neurol Ther. 2021 Dec;10(2):539–55. 10.1007/s40120-021-00260-5. PubMed DOI PMC

Gold R, Fätkenheuer G, Hartung HP, Kleinschnitz C, Marks R, Maschke M, et al. . Vaccination in multiple sclerosis patients treated with highly effective disease-modifying drugs: an overview with consideration of cladribine tablets. Ther Adv Neurol Disord. 2021;14:17562864211019598. 10.1177/17562864211019598. PubMed DOI PMC

Bhise V, Dhib-Jalbut S. Potential risks and benefits of multiple sclerosis immune therapies in the COVID-19 era: clinical and immunological perspectives. Neurotherapeutics. 2021 Jan;18(1):244–51. 10.1007/s13311-021-01008-7. PubMed DOI PMC

Wu X, Wang L, Shen L, Tang K. Response of COVID-19 vaccination in multiple sclerosis patients following disease-modifying therapies: a meta-analysis. eBioMedicine. 2022 Jul;81:104102. 10.1016/j.ebiom.2022.104102. PubMed DOI PMC

Golshani M, Hrdý J. Multiple sclerosis patients and disease modifying therapies: impact on immune responses against COVID-19 and SARS-CoV-2 vaccination. Vaccines. 2022 Feb 11;10(2):279. 10.3390/vaccines10020279. PubMed DOI PMC

Reder AT, Stuve O, Tankou SK, Leist TP. T cell responses to COVID-19 infection and vaccination in patients with multiple sclerosis receiving disease-modifying therapy. Mult Scler. 2022 Nov 28;135245852211342. 10.1177/13524585221134216. PubMed DOI PMC

Sellner J, Rommer PS. Multiple sclerosis and SARS-CoV-2 vaccination: considerations for immune-depleting therapies. Vaccines. 2021 Jan 28;9(2):99. 10.3390/vaccines9020099. PubMed DOI PMC

Kim E, Haag A, Nguyen J, Kesselman MM, Demory Beckler M. Vaccination of multiple sclerosis patients during the COVID-19 era: novel insights into vaccine safety and immunogenicity. Mult Scler Relat Disord. 2022 Nov;67:104172. 10.1016/j.msard.2022.104172. PubMed DOI PMC

Hollen C, Bernard J. Multiple sclerosis management during the COVID-19 pandemic. Curr Neurol Neurosci Rep. 2022 Aug;22(8):537–43. 10.1007/s11910-022-01211-9. PubMed DOI PMC

Yamout BI, Zakaria M, Inshasi J, Al-Jumah M, Zeineddine M, Dahdaleh M, et al. . MENACTRIMS practice guideline for COVID-19 vaccination in patients with multiple sclerosis. Mult Scler Relat Disord. 2021 Nov;56:103225. 10.1016/j.msard.2021.103225. PubMed DOI PMC

Al Jumah M, Abulaban A, Aggad H, Al Bunyan R, AlKhawajah M, Al Malik Y, et al. . Managing multiple sclerosis in the Covid19 era: a review of the literature and consensus report from a panel of experts in Saudi Arabia. Mult Scler Relat Disord. 2021 Jun;51:102925. 10.1016/j.msard.2021.102925. PubMed DOI PMC

Muñoz-Jurado A, Escribano BM, Agüera E, Caballero-Villarraso J, Galván A, Túnez I. SARS-CoV-2 infection in multiple sclerosis patients: interaction with treatments, adjuvant therapies, and vaccines against COVID-19. J Neurol. 2022 Sep;269(9):4581–603. 10.1007/s00415-022-11237-1. PubMed DOI PMC

Rieckmann P, Centonze D, Giovannoni G, Hua LH, Oreja-Guevara C, Selchen D, et al. . Expert opinion on COVID-19 vaccination and the use of cladribine tablets in clinical practice. Ther Adv Neurol Disord. 2021;14:17562864211058298. 10.1177/17562864211058298. PubMed DOI PMC

Tornatore C, Wiendl H, Lublin AL, Geertsen SS, Chavin J, Truffinet P, et al. . Vaccine response in patients with multiple sclerosis receiving teriflunomide. Front Neurol. 2022;13:828616. 10.3389/fneur.2022.828616. PubMed DOI PMC

Giovannoni G, Mathews J. Cladribine tablets for relapsing-remitting multiple sclerosis: a clinician’s review. Neurol Ther. 2022 Jun;11(2):571–95. 10.1007/s40120-022-00339-7. PubMed DOI PMC

Inshasi JS, Alfahad S, Alsaadi T, Hassan A, Zein T, Mifsud VA, et al. . Position of cladribine tablets in the management of relapsing-remitting multiple sclerosis: an expert narrative review from the United Arab Emirates. Neurol Ther. 2021 Dec;10(2):435–54. 10.1007/s40120-021-00243-6. PubMed DOI PMC

Moser T, Ziemssen T, Sellner J. Real-world evidence for cladribine tablets in multiple sclerosis: further insights into efficacy and safety. Wien Med Wochenschr. 2022 Nov;172(15–16):365–72. 10.1007/s10354-022-00931-4. PubMed DOI PMC

Louapre C, Collongues N, Stankoff B, Giannesini C, Papeix C, Bensa C, et al. . Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis. JAMA Neurol. 2020 Sep 1;77(9):1079. 10.1001/jamaneurol.2020.2581. PubMed DOI PMC

Gombolay GY, Dutt M, Tyor W. Immune responses to SARS-CoV-2 vaccination in multiple sclerosis: a systematic review/meta-analysis. Ann Clin Transl Neurol. 2022 Aug;9(8):1321–31. 10.1002/acn3.51628. PubMed DOI PMC

Pugliatti M, Hartung HP, Oreja-Guevara C, Pozzilli C, Airas L, Alkhawajah M, et al. . Anti-SARS-CoV-2 vaccination in people with multiple sclerosis: lessons learnt a year in. Front Immunol. 2022 Oct 17;13:1045101. 10.3389/fimmu.2022.1045101. PubMed DOI PMC

Bellucci G, Rinaldi V, Buscarinu MC, Reniè R, Bigi R, Pellicciari G, et al. . Multiple sclerosis and SARS-CoV-2: has the interplay started? Front Immunol. 2021 Sep 27;12:755333. 10.3389/fimmu.2021.755333. PubMed DOI PMC

Margoni M, Preziosa P, Filippi M, Rocca MA. Anti-CD20 therapies for multiple sclerosis: current status and future perspectives. J Neurol. 2022 Mar;269(3):1316–34. 10.1007/s00415-021-10744-x. PubMed DOI PMC

Saad N, Moussa S. Immune response to COVID-19 infection: a double-edged sword. Immunol Med. 2021 Jul 3;44(3):187–96. 10.1080/25785826.2020.1870305. PubMed DOI

Kulikowska J, Kulczyńska-Przybik A, Mroczko B, Kułakowska A. The significance of COVID-19 immunological status in severe neurological complications and multiple sclerosis-A literature review. Int J Mol Sci. 2021 May 31;22(11):5894. 10.3390/ijms22115894. PubMed DOI PMC

Sormani MP, De Rossi N, Schiavetti I, Carmisciano L, Cordioli C, Moiola L, et al. . Disease-modifying therapies and coronavirus disease 2019 severity in multiple sclerosis. Ann Neurol. 2021 Apr;89(4):780–9. 10.1002/ana.26028. PubMed DOI PMC

COVID-19 Vaccine Tracker . Vaccines types. [Internet] [cited 2022 Dec 02]. Available from: https://covid19.trackvaccines.org/vaccine-types/.

Mascellino MT, Di Timoteo F, De Angelis M, Oliva A. Overview of the main anti-SARS-CoV-2 vaccines: mechanism of action, efficacy and safety. Infect Drug Resist. 2021 Aug;14:3459–76. 10.2147/IDR.S315727. PubMed DOI PMC

COVID19 Vaccine Tracker, Vaccines candidates in clinical trials. [Internet] [cited 2022 Dec 02]. Available from: https://covid19.trackvaccines.org/vaccines/.

European Medicines Agency . COVID-19 vaccines: authorised. [Internet] [cited 2022 Dec 10]. Available from: https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/vaccines-covid-19/covid-19-vaccines-authorised#adapted-covid-19-vaccines-section.

Dan JM, Mateus J, Kato Y, Hastie KM, Yu ED, Faliti CE, et al. . Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection. Science. 2021 Feb 5;371(6529):eabf4063. 10.1126/science.abf4063. PubMed DOI PMC

Limaye S. Abnormal laboratory results: tests for cell-mediated immunity. Aust Prescr. 2010 Jun 1;33(3):84–7. 10.18773/austprescr.2010.041. DOI

Apostolidis SA, Kakara M, Painter MM, Goel RR, Mathew D, Lenzi K, et al. . Cellular and humoral immune responses following SARS-CoV-2 mRNA vaccination in patients with multiple sclerosis on anti-CD20 therapy. Nat Med. 2021 Nov;27(11):1990–2001. 10.1038/s41591-021-01507-2. PubMed DOI PMC

Achiron A, Dolev M, Menascu S, Zohar DN, Dreyer-Alster S, Miron S, et al. . COVID-19 vaccination in patients with multiple sclerosis: what we have learnt by February 2021. Mult Scler. 2021;27(6):864–70. 10.1177/13524585211003476. PubMed DOI PMC

Dreyer-Alster S, Menascu S, Mandel M, Shirbint E, Magalashvili D, Dolev M, et al. . COVID-19 vaccination in patients with multiple sclerosis: safety and humoral efficacy of the third booster dose. J Neurol Sci. 2022 Mar 15;434:120155. 10.1016/j.jns.2022.120155. PubMed DOI PMC

Sharif N, Alzahrani KJ, Ahmed SN, Dey SK. Efficacy, immunogenicity and safety of COVID-19 vaccines: a systematic review and meta-analysis. Front Immunol. 2021 Oct 11;12:714170. 10.3389/fimmu.2021.714170. PubMed DOI PMC

Ismail II, Salama S. A systematic review of cases of CNS demyelination following COVID-19 vaccination. J Neuroimmunol. 2022 Jan;362:577765. 10.1016/j.jneuroim.2021.577765. PubMed DOI PMC

European Medicine Agency . COVID-19 Vaccine Jannsen: EMA finds possible link to very rare cases of unusual blood clots with low blood platelets. [Internet] [cited 2022 Dec 06]. Available from: https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-provide-further-context-risk-very-rare-blood-clots-low-blood).

Czarnowska A, Tarasiuk J, Zajkowska O, Wnuk M, Marona M, Nowak K, et al. . Analysis of side effects following vaccination against COVID-19 among individuals with multiple sclerosis treated with DMTs in Poland. Front Neurol. 2022 Jun 14;13:913283. 10.3389/fneur.2022.913283. PubMed DOI PMC

National Multiple Sclerosis Society . COVID-19 vaccine guidance for people living with MS. [Internet] [cited 2022 Dec 02]. Available from: https://www.nationalmssociety.org/coronavirus-covid-19-information/covid-19-vaccine-guidance.

European Multiple Sclerosis Platform, Updated global COVID-19 advice for people with MS. [Internet] [cited 2022 Dec 02]. Available from: https://emsp.org/news/global-covid-19-advice-for-people-with-ms/.

Ghaderi S, Berg-Hansen P, Bakken IJ, Magnus P, Trogstad L, Håberg SE. Hospitalization following influenza infection and pandemic vaccination in multiple sclerosis patients: a nationwide population-based registry study from Norway. Eur J Epidemiol. 2020 Apr;35(4):355–62. 10.1007/s10654-019-00595-2. PubMed DOI PMC

Monschein T, Hartung HP, Zrzavy T, Barnett M, Boxberger N, Berger T, et al. . Vaccination and multiple sclerosis in the era of the COVID-19 pandemic. J Neurol Neurosurg Psychiatry. 2021 Oct;92(10):1033–43. 10.1136/jnnp-2021-326839. PubMed DOI PMC

Cencioni MT, Genchi A, Brittain G, de Silva TI, Sharrack B, Snowden JA, et al. . Immune reconstitution following autologous hematopoietic stem cell transplantation for multiple sclerosis: a review on behalf of the EBMT Autoimmune Diseases Working Party. Front Immunol. 2022;12:813957. PubMed PMC

Hauer L, Sellner J. Diroximel fumarate as a novel oral immunomodulating therapy for relapsing forms of multiple sclerosis: a review on the emerging data. Drug Des Devel Ther. 2022;16:3915–27. PubMed PMC

Find record

Citation metrics

Loading data ...

Archiving options

Loading data ...