Should You Get the COVID Vaccine If You Have MS?
Claire Riley, M.D., answers questions about multiple sclerosis and the new COVID shots.
The COVID-19 vaccines are here, and they’re being distributed by the millions. Chances are, you know at least one person who has received one. But as welcome as these long-awaited shots are, they’re also stirring up some controversy—especially among those in the chronic community, who (understandably) have some questions. Like are these vaccines safe for everyone? And will they interact with my medications? Also, what are the side-effect risks?
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We hear you. And we’re taking your questions straight from our Facebook pages to the desks of top chronic disease experts as part of our original series #ChronicVaxFacts. For this multiple sclerosis-focused installment, we interviewed Claire S. Riley, M.D., medical director of the Columbia Multiple Sclerosis Center in New York, NY. Here’s what she had to say:
HealthCentral: Could the COVID vaccine cause a flare-up or make my MS symptoms worse?
Claire S. Riley, M.D.: Just to level set, we don’t have much information about how the COVID vaccines currently approved in this country potentially impact individuals with multiple sclerosis. People with autoimmune disease were largely excluded from all the global clinical vaccination trials, so we operate in a data-free zone here.
What we do know is that the vaccine can induce flu-like symptoms in people who receive it. Sometimes that includes fever, and fever is well-known to worsen MS symptoms and bring out symptoms that aren’t otherwise noticeable. Many of my patients who have been vaccinated have mentioned that in the day or two after getting an mRNA vaccine—and especially after the second dose—they may be a bit more symptomatic with their prior MS symptoms. We recommend taking acetaminophen or ibuprofen if you are having fever after the vaccine. I wouldn’t recommend pre-treating with those because that might decrease the effectiveness of the vaccine.
One thing that’s more immune-stimulating than the vaccine is COVID. We’ve seen people who had inflammation after COVID infection, so people would potentially have some risk of stimulating their disease if they don’t get vaccinated and instead get COVID. We are in alignment with the National MS Society’s recommendation for MS patients to get vaccinated, and we think that the risk that patients will have an attack of MS related to the vaccine is relatively low.
HC: Is it safe to get the vaccine while on my disease-modifying drugs?
Dr. Riley: Again, we’re using our best judgement since patients were excluded from the trials, but we think they would be safe to receive the vaccination on any MS therapies. There’s no way to get COVID from any of the COVID vaccines. The next question becomes, is that vaccine going to be effective in MS patients? There are some issues related to the different mechanisms of action in MS therapies. Particularly with the B-cell directed therapies—which would include ocrelizumab, rituximab, and ofatumumab—there are some considerations regarding timing, so that you time the vaccination at a point where your body can respond to the vaccine appropriately.
HC: Is one vaccine better than the other for people with MS?
Dr. Riley: The Pfizer and Moderna vaccines have the same mechanism. They are mRNA-based vaccines based on the spike protein of the coronavirus molecule. Right now, we have the most experience with the mRNA vaccines and tend to favor those.
The AstraZeneca vaccine is an adenovirus vector vaccine that has been linked to two cases of transverse myelitis (inflammation in the spiral cord). One was in a person who probably had undiagnosed or under-recognized MS, and one was in somebody with no prior neurologic history. The full Phase 3 data for Johnson & Johnson has not been published, but since it uses the same mechanism as AstraZeneca, we have generally encouraged our patients to opt for an mRNA-based vaccine while more data emerges for review.
HC: Should I stop taking any medications before getting the vaccine?
Dr. Riley: Probably not. We are modifying some dosing strategies of those B-cell therapies to allow for timely vaccination, but a challenge that our patients have had is anticipating when they will become eligible for vaccination. Eligibility criteria has shifted frequently, so it is hard to anticipate the date of vaccination and coordinate with treatment, particularly in treatments dosed every six months. Keep your eye on the news, but I think that the timing around B-cell therapy is probably the most important.
HC: Do I need to be worried about severe side effects from the COVID vaccine?
Dr. Riley: People may have worsening of their MS symptoms for a few days, especially after the second vaccination. That’s probably related to fever. As far as the acute hypersensitivity or anaphylactic reactions, I don’t think our patients would be more at risk for those. If you had a history of anaphylaxis to other vaccines or medications, then it would be a concern, but it’s not an MS-specific problem.
HC: People with autoimmune diseases were not included in the clinical trials. So, does that mean we are going to be the guinea pigs?
Dr. Riley: We’d always prefer that there were people just like our patients in clinical trials. I would rather that MS patients had their own studies before they got this. But this is the data we have. This is a tremendous public health emergency, and the isolation that our patients have experienced is terribly problematic for their well-being. Still, I encourage and am practicing careful vigilance—reporting anything that looks or smells like an adverse event in my patients. Vaccine hesitancy is a big issue in this country, and people in this situation don’t just risk their own well-being but the well-being of the community when they decide not to get vaccinated. There is the citizenship-public responsibility piece, and then there is the self-protection piece. And you have to do your best to integrate those and follow your own moral compass.
HC: What are scientists doing to get that data on vaccine safety for people with our condition, and when will we have access to that information?
Dr. Riley: We are following the clinical outcomes of our patients who have been vaccinated. We are collecting blood to look at the impact of the vaccination on markers of inflammation. I don’t expect a major reveal from that in the short term, but I think it is worth it to bank those samples and gain the power of numbers over time to make that analysis. We’re reporting to groups like the CDC if there are cases that seem concerning or an adverse event related to vaccination. That’s part of our responsibility as providers and something we take very seriously.
- National MS Society COVID Vaccine Recommendations: National Multiple Sclerosis Society. (2021). “COVID-19 Vaccine Guidance for People Living with MS.” nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance