Guidance on Additional COVID-19 Vaccine Dose for MS Patients

Erik Greb

August 20, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Patients age 12 years and older with multiple sclerosis (MS) who are fully immunized against COVID-19 with either the Pfizer-BioNTech or Moderna mRNA vaccine may be eligible to receive an additional dose now, the National Multiple Sclerosis Society has announced.

New guidance, which is "based on available data from studies and expert consensus opinion" by a panel of MS neurologists and experts, was published yesterday on the organization's website.

The US Food and Drug Administration (FDA) has authorized an additional dose of the coronavirus vaccine for patients who are expected to not have a normal or adequate immune response to the first two doses. Patients with MS who use certain treatments have a reduced or absent antibody response to the vaccine, according to recent data.

"We want people living with MS to be aware of this additional dose and discuss when they need an additional dose or booster dose with their healthcare provider," Julie Fiol, RN, MSW, associate vice president of healthcare access, National MS Society, told Medscape Medical News.

Those who may benefit from an additional dose include patients with MS who use sphingosine 1-phosphate receptor modulators, anti-CD20 monoclonal antibodies, or alemtuzumab (Lemtrada), the National MS Society notes. These particular disease modifying therapies (DMTs) have a stronger effect on the immune system than other treatments.

Protecting "the Most Vulnerable"

Sphingosine 1-phosphate receptor modulators include fingolimod (Gilenya), siponimod (Mayzent), ozanimod (Zeposia), and ponesimod (Ponvory).

Anti-CD20 monoclonal antibodies include ocrelizumab (Ocrevus), ofatumumab (Kesimpta), rituximab (Rituxan), and corresponding biosimilars.

Current data do not support an additional dose for immunocompromised patients who received the Johnson & Johnson vaccine. The FDA and the Centers for Disease Control and Prevention are developing recommendations for these patients, and the National MS Society will update its guidance as needed, the organization noted in its statement.

"Like other medical decisions, the decision to get an additional dose is best made in partnership with your healthcare provider," said Fiol. "Talk to your MS healthcare provider to determine what is best for you."

MS itself does not compromise the immune system, but some MS therapies alter the immune system and reduce the body's response to vaccination. Patients with MS who use B cell-depleting therapies have a better antibody response when they receive the vaccine 3 months or more after the last dose of MS therapy, the Society said.  

Data suggest that patients with MS are not more susceptible to COVID-19 infection, severe illness, or death than patients without MS. However, certain groups of patients with MS, such as those who receive B cell-depleting treatments, are more susceptible to having a severe case of COVID-19.

That said, "everyone will need a booster at some point. Those who take DMTs that have greater impact on the immune system are the most urgent need now," the organization noted.

"Vaccination against COVID-19 is critical for public safety and, especially, the safety of the most vulnerable among us," said Fiol. "We encourage everyone with MS get vaccinated."

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