Research Inquiry – Raleigh Neurology Associates

August 18, 2021

Many of our patients living with chronic conditions, including MS, have ongoing questions regarding the COVID-19 vaccine. We want to share the latest vaccine information we have with you. The rise of COVID-19 cases in our community due to the Delta Variant has been very worrisome. Vaccination against COVID-19 remains the best way to prevent severe disease, hospitalization, and death. Please continue social distancing and masking indoors to further prevent the spread of COVID-19.

If you are in North Carolina, please visit https://covid19.ncdhhs.gov/findyourspot for available vaccine locations.

Vaccine Booster information
We agree with the CDC recommendation for a third dose of the mRNA vaccines (Pfizer for 12 years and older, and Moderna for 18 years and older) for patients who are “moderately to severely” immunocompromised. If you are on a disease modifying agent for MS, you qualify as a patient who is moderately to severely immunocompromised based on the use of these immunomodulatory medications. If you have MS but have not been on a disease modifying therapy within the last year, you are likely no longer immunosuppressed and do not currently need a third dose. Some exceptions may apply, so please ask your doctor if you are unsure.

A few points:

The third dose of mRNA vaccine should be, if possible, the same brand as the first two. An exception can be made if this is not possible.
This will be a “honors system.” No extra documentation will be needed.
Patients should wait at least 28 days after first two doses.
There is not enough data as to whether patients who received Johnson & Johnson (J&J) vaccine should have a booster of J&J or mRNA vaccine, and these patients are not included in this recommendation.

COVID-19 Guidance for People Living with MS
We concur with the National MS Society’s recommendation that individuals with MS should get the COVID-19 vaccination. The currently available COVID-19 vaccines authorized by the FDA for emergency use are not live-virus vaccines, and we therefore believe their use will be safe for the all of our patients. The current vaccines have been shown to significantly reduce the risk of COVID-19 infection (including the Delta Variant) and also to significantly reduce the risk of hospitalization and death from COVID. The vaccines are recommended for people who have not had COVID-19 and for those who have already had COVID-19. Individuals who have experienced severe allergic reactions with previous vaccinations should discuss with their provider the risks and benefits of the COVID-19 vaccination. These vaccines are recommended for women who are pregnant or breastfeeding.

Additional information on the COVID-19 vaccines from the MS Society can be accessed at https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance.

COVID-19 Vaccination Timing & MS Medications
The timing and efficacy of the vaccine will depend at least in part on your MS medication. Some medicines, like Ocrevus, Kesimpta, Mavenclad, Lemtrada, and Rituxan, lower your number of B-cells, which are the cells that make antibodies. It is possible that people receiving these medications may not have a full antibody response to the vaccine. Please follow the recommendations below on the timing to receive your vaccine based on what medication you take to treat your MS. These guidelines are based on the Pfizer, Moderna, and J&J vaccines which do not contain live virus and are subject to change based on new vaccines &/or information released.

Note: For vaccines that require multiple doses/injections (i.e., Pfizer and Moderna), the 2^nd dose must be completed prior to the MS therapy treatment noted

Therapy	Recommendation
Injections	Including (Avonex, Betaseron, Copaxone, Extavia, Glatopa, Glateramer Acetate, Plegridy, Rebif): can receive the vaccine injection at any time once available. Kesimpta: anytime
Oral Therapies	Gilenya/Zeposia/Mayzent/Ponvory: anytime. Tecfidera/Vumerity/Bafiertam: anytime. Aubagio: anytime. Mavenclad: 1 month before* taking the medication or 2 months after.
Infusion Therapies	Tysabri: No timing modification required; continue with current infusion schedule. Ocrevus: 2 weeks before* or 2 months after infusion. Rituxan: 2 weeks before* or 2 months after infusion. Lemtrada: 1 month before* infusion or 2 months after infusion. IV Solumedrol: 2 weeks after steroid infusion

* 2^nd dose of vaccine (if applicable) must be completed prior to the MS therapy treatment noted.

Thank you,

Raleigh Neurology Associates