The MS Immune System: Suppressed, Compromised, or What?

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by Ed Tobias |

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Lately, I’ve seen a lot of incorrect information on social media about how multiple sclerosis affects our immune system. Some of it seems to be prompted by concerns that MS makes someone more susceptible to COVID-19, or confusion about whether people with MS can safely receive a COVID-19 vaccine.

Here are a couple examples:

Immunosuppressed or immunocompromised?

One person with MS wrote online that he is “immunosuppressed.” But MS does not weaken the immune system. Some disease-modifying therapies (DMTs) are designed to do that, however.

Another thinks she should be in a priority group for the COVID-19 vaccine because her immune system is “immunocompromised.”

Nope. MS isn’t on the U.S. Centers for Disease Control and Prevention’s list of medical conditions that increase the risk of infection with the novel coronavirus. That’s because MS doesn’t reduce the ability of the immune system to fight off a viral or bacterial attack. MS attacks the central nervous system, not the immune system. In fact, our immune systems are a bit super active.

We are immune-mediated

MS is an autoimmune disease. It’s among a group of about 80 illnesses in which the immune system mistakenly attacks a part of the body. Rogue immune cells target healthy tissue as if it were a harmful virus, bacteria, or cancer. In MS, the targets of this attack are the brain, the nerves along the spine, or both. The U.S. National Multiple Sclerosis Society refers to this as being immune-mediated.

Believing in “KISS” (“Keep it simple, stupid”), my nonscientific description of people with MS is that our immune system is messed up, or our nerves are literally frayed. 

DMTs are designed to control this abnormal activity. Some attempt to disrupt the activation of unruly immune cells, some try to reduce the number of these cells, and others try to block the movement of these cells into the central nervous system from the circulatory system.

Because DMTs are designed to reduce the activity of immune system cells, scientists think some may also reduce the ability of the immune system to fight the coronavirus. So, although MS isn’t on the CDC’s list of conditions that increase COVID-19 risk, it’s recommended that people with MS coordinate the timing of some treatments if a COVID-19 vaccination is planned.

That’s good advice, no matter how you label your disease.

You’re invited to visit my personal blog at www.themswire.com.

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Comments

Hannah avatar

Hannah

I haven't seen these examples but I'm not convinced that people aren't aware of this distinction. MS does not compromise the immune system but a great number of people with RRMS are on immune system modifying therapies that increase their risk of infection. This includes upper and lower respiratory infections similar to COVID. Someone on this type of medication is correct in saying that they are immunosuppressant. Maybe some people don't understand that it is the medication causing this and not MS itself but the examples don't really show that.

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Ed Tobias avatar

Ed Tobias

Hi Hannah,

You're absolutely correct about some DMTs reducing the ability of our immune system to fight some infection, at least for period of time. As you write, some people (I'd say many people) are confused about immunosuppression, what causes it and how long it may last. It's a discussion that their neuros should have with their MS patients but I think that too many fail to have it, or aren't clear in their explanation.

Thanks for commenting,

Ed

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Jessie Wiebe avatar

Jessie Wiebe

yes I agree Hannah. I personally have RRMS - and do daily injections of Copaxone. When I read this article and it says we must strategically coordinate the timing - [it’s recommended that people with MS coordinate the timing of some treatments if a COVID-19 vaccination is planned.]....my question is how do I coordinate the timing when I do DAILY injections of Copaxone. AND I do not believe studies have been done to test how these 2 medications will interact. Why should I become yet another guinea pig?? When clealy the lab studies are not completed before immunization of this Vaccine is given for a mutating virus. Really?? Who is missing some brain cells here???

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Ed Tobias avatar

Ed Tobias

Thanks for your comments, Jesse.

Here's what the National MS Society says about getting a COVID vaccine:

The science has shown us that the COVID-19 vaccines are safe and effective. Like other medical decisions, the decision to get a vaccine is best made in partnership with your healthcare provider. Most people with relapsing and progressive forms of MS should be vaccinated. The risks of COVID-19 outweigh any potential risks from the vaccine."

The guidance about timing is aimed at the DMTs that significantly reduce the immune system for a period of time:

"Some DMTs may make the vaccine less effective but it will still provide some protection. For those taking Kesimpta, Lemtrada, Ocrevus, or Rituxan—you may consider coordinating the timing of your vaccine with the timing of your DMT dose. Work with your MS healthcare provider to determine the best schedule for you."

Copaxone isn't among those. Regarding it and similar glatiramer acetate medications the NMSS says:

"Do not delay starting one of these medicines for your vaccine injection. If you are already taking one of these DMTs, no adjustments of your DMT administration are recommended."

I've written about all of this in earlier columns but perhaps you haven't seen those. I hope the information is useful.

Ed

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Ruth Hoham avatar

Ruth Hoham

My neurologist suggested that our immune systems are “super-charged” and may in fact make us less likely to be affected by the virus. That makes sense to me, but I’m not relying on it - got fully vaccinated recently!
Highly recommended!!

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Ed Tobias avatar

Ed Tobias

Hi Ruth,

Super-charged is another good description but, like you, I don't expect it to super-protect me from anything. I'm two and a half weeks post Moderna shot number two and I'm very glad I got those jabs.

Ed

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Paula Kulp avatar

Paula Kulp

I’m receiving conflicting advice as to how soon I can have my Rituxan treatment after I receive the 2nd COVID vaccine.
Any thoughts?

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Ed Tobias avatar

Ed Tobias

Hi Paula,

Here's what the National MS Society says about Rituxan and Ocrevus:

"If you are about to start Ocrevus or Rituxan, consider getting fully vaccinated* 2-4 weeks or more prior to starting the infusions. If you are already taking Ocrevus or Rituxan, consider getting vaccinated 12 weeks or more after the last DMT dose3. When possible, resume Ocrevus or Rituxan 4 weeks or more after getting fully vaccinated*. This suggested scheduling is not always possible and getting the vaccine when it becomes available to you may be more important than timing the vaccine with your MS medicine. Work with your MS healthcare provider to determine the best schedule for you."

I hope this info helps but, of course, you should discuss this with your neuro.

Ed

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Jan avatar

Jan

I discovered this site for the first time today. I have Secondary progressive MS after an initial diagnosis of RRMS 27 years ago. But my symptoms began when I was a teenager 53 years ago when there were no MRIs or other diagnostic tools. In all that time, I have never seen or heard a clearer explanation of the effect of MS on the immune system Thank you for your clarification.

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Ed Tobias avatar

Ed Tobias

Hi Jan,

I'm sorry for the delay in seeing your comment. I'm so glad you thought the explanation was clear. What you wrote made my day.

Ed

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