Preventive Medicine and Epidemiology Department. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona.
Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
Curr Opin Neurol. 2021 Jun 1;34(3):322-328. doi: 10.1097/WCO.0000000000000929.
This review focuses on new evidence supporting the global immunization strategy for multiple sclerosis (MS) patients receiving disease-modifying drugs (DMDs), including the recently available vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
New data strengthen the evidence against a causal link between MS and vaccination. Recent consensus statements agree on the need to start vaccination early. Timings for vaccine administration should be adjusted to ensure safety and optimize vaccine responses, given the potential interference of DMDs. Patients treated with Ocrelizumab (and potentially other B-cell depleting therapies) are at risk of diminished immunogenicity to vaccines. This has relevant implications for the upcoming vaccination against SARS-CoV-2.
An early assessment and immunization of MS patients allows optimizing vaccine responses and avoiding potential interference with treatment plans. Vaccinations are safe and effective but some specific considerations should be followed when vaccinating before, during, and after receiving immunotherapy. A time-window for vaccination taking into account the kinetics of B cell repopulation could potentially improve vaccine responses. Further understanding of SARS-CoV-2 vaccine response dynamics in MS patients under specific therapies will be key for defining the best vaccination strategy.
本综述重点介绍了支持多发性硬化症（MS）患者接受疾病修正治疗（DMD）的全球免疫策略的新证据，包括最近可用于预防严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的疫苗。
新数据强化了 MS 与疫苗接种之间无因果关系的证据。最近的共识声明一致认为需要早期开始接种疫苗。鉴于 DMD 可能存在干扰，应调整疫苗接种时间以确保安全性并优化疫苗反应。接受奥瑞珠单抗（和潜在的其他 B 细胞耗竭疗法）治疗的患者对疫苗的免疫原性可能降低。这对即将进行的 SARS-CoV-2 疫苗接种具有重要意义。
早期评估和免疫接种 MS 患者可以优化疫苗反应，并避免潜在的治疗计划干扰。疫苗接种安全有效，但在免疫治疗之前、期间和之后接种疫苗时需要考虑一些具体问题。考虑到 B 细胞再增殖动力学的疫苗接种时间窗口可能会改善疫苗反应。进一步了解特定治疗方案下 MS 患者对 SARS-CoV-2 疫苗的反应动态，将是确定最佳疫苗接种策略的关键。
