Efficacy of Pfizer-BioNTech COVID-19 Vaccine Varies by DMT, Study Finds

by Ed Tobias | May 14, 2021

Are you being treated with a disease-modifying therapy (DMT) and wondering how it might affect the efficacy of an mRNA-based COVID-19 vaccine? If so, a recent study may provide some clarity.

The study, published in Therapeutic Advances in Neurological Disorders, looked at 125 MS patients either being treated with cladribine, ocrelizumab, or fingolimod, or no DMT. A control group of healthy people also was included.

Study participants were tested 4.5 to 6.5 weeks after receiving a second shot of the Pfizer-BioNTech COVID-19 vaccine. The difference in how well the vaccine protected members of each group was dramatic.

DMTs react differently to the COVID-19 vaccine

The goal of the Pfizer-BioNTech COVID-19 vaccine and others like it is to generate a robust amount of antibodies in the bloodstream to protect against SARS-CoV-2, the coronavirus that causes COVID-19. But the goal of many DMTs, on the other hand, is to modulate, or reduce activity in, the immune system. So, there can be a conflict between what the two medications are trying to achieve.

In this study, conducted by researchers at Israel’s Sheba Medical Center, immunity to SARS CoV-2 was achieved in 97.9% of the healthy people, and in 100% of patients with MS who were not being treated with a DMT. Patients being treated with cladribine also achieved 100% protective immunity.

At the other end of the scale were those being treated with ocrelizumab or fingolimod. Only 22.7% and 3.8% of them, respectively, developed protective antibodies to SARS-CoV-2.

Why is this?

The researchers suggested a couple of reasons for the poor response of ocrelizumab and fingolimod. First, they noted that other research has determined that MS patients treated with these two DMTs have poor responses to other vaccines, including seasonal flu and tetanus vaccines.

They also believe that the low response of patients on fingolimod may have been because the DMT is designed to lower a patient’s lymphocyte count, which creates a greater hurdle for the COVID-19 vaccine to overcome.

According to the study, ocrelizumab depletes naive and memory B lymphocytes, the cells responsible for generating antibodies. And with treatment every six months, ocrelizumab continues to knock the lymphocytes down. As with fingolimod, this depletion likely reduces the ability of the COVID-19 vaccine to do its job, which makes it difficult to schedule a vaccination without interrupting ocrelizumab’s treatment schedule.

The researchers didn’t test other high-efficacy DMTs, such as Lemtrada (alemtuzumab), nor did they research other COVID-19 vaccines. I’ve been treated with Lemtrada and received the Moderna vaccine, and would very much like to know whether my DMT affected the vaccine’s efficacy.

Recommendations

The researchers recommend “postponing ocrelizumab treatment in MS patients willing to be vaccinated as a protective humoral response can be expected only in some.”

They did not recommend vaccinating patients being treated with fingolimod.

On the other hand, those at the National Multiple Sclerosis Society (NMSS) see things a bit differently. Experts there stated that, “Some DMTs may make the [COVID-19] 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.”

My opinion is that if you’re wondering about all of this, you should consult your neurologist and discuss receiving a COVID-19 vaccine no matter what DMT you take. As the NMSS noted, even if your DMT significantly reduces the vaccine’s efficacy, some protection is better than none.

What do you think? Please share your thoughts in the comments below. You’re also 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.

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About the Author

Ed Tobias People say to write what you know and Ed Tobias knows about MS. He's lived with the illness since 1980, when he was 32 years old. Ed's a retired, award-winning broadcast journalist and his column combines his four decades of MS experiences with news and comments about the latest in the MS community. In addition to writing his column, Ed is one of the patient moderators on the MS News Today Facebook, Twitter, and Instagram sites. He’s also the author of “The Multiple Sclerosis Toolbox: Hints and Tips for Living with M.S.” Ed and his wife split their time between the Washington, D.C. suburbs and Florida’s Gulf Coast, trying to follow the sun.

Comments

Leanne Broughton

What about a viral vector
like J & J or AstraZeneca?

Ed Tobias

Leanne,

The study I wrote about only studied the Pfizer vaccine. I assume the interaction with the Moderna vaccine would be similar, since it's also an mRNA vaccine. I don't know about the others.

Charles Lumia

Good info. My doctor wants me to swap to Ocrevus and says that I should get vaccinated first because of worries like this.

I'm on Tecfidera right now. I wonder if that has an effect too.

Ed Tobias

Hi Charles,

Tecfidera seems quite different from Ocrevus in the way it interacts with the vaccine. Here's some info from the National MS Society. https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance/Timing-MS-Medications-with-COVID-19-Vaccines

Amanda

You mentioned nothing about Tysabri (natalizumab)...

Ed Tobias

Amanda,

There was nothing about it in this study. But here's some general guidance from the National MS Society. https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance/Timing-MS-Medications-with-COVID-19-Vaccines

Dominic

Where are we now is important.

I wrote about the patient perspective on this topic at the request of Professor Giovannoni for the Barts Blog - https://multiple-sclerosis-research.org/2021/04/guest-post-from-an-ocrelizumaber/ - and since then the topic has developed further.

The recent pre/print publication of the paper on bioRX about T cell response to vaccine regardless of the effect on B-cells gives hope.

It now appears that T-cells play an even greater role in the outcome of a SAS-Cov2 infection.

Ed Tobias

Thanks for this information, Dominic.

I'm read something similar about T-cells. As you say, we continue to learn about this virus and how it interacts with the vaccines, treatments and various diseases. So, I just keep reading.

Daniel L Grambo

Ed, my DMT- Avonex period of use was 2001 to 2016, do we know if my immune system still has antibodies in my system?

Ed Tobias

Daniel,

I'm sorry but I don't know the answer to that. It's a better question for your neuro than for me.

Eliza

I've just started the new treatment with Tecfidera (Dimetyl Fumarate) on 27th of April. Are there studies regarding this and the conditions I could be vaccinated?

Ed Tobias

I'm not aware of a study similar to the one I wrote about but here's a list of DMTs and the recommendations for each from the National MS Society. https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance/Timing-MS-Medications-with-COVID-19-Vaccines

Paul

First let me say that I read your columns regularly either directly on your blog or through this MS News today site. It is all very informative and very useful. Thank you.
I have been on Ocrevus since just after it was approved. The direction I received from my neurologist was to get the Pfizer vaccine smack dab in the middle of my treatments. So three months after my last treatment I got my first shot and this coming Wednesday I get my second shot. I do believe that some protection is better than none however without any certainty as to its effectiveness, I can’t see letting my guard down in anyway from the potential of being infected. Do you have any insight as to how one might get tested for the protective antibodies. I will also check with my neurologist. At least knowing will lead me to make informed decisions on day to day activities, masks social distancing etc.
Hope you’re enjoying the weather in Florida

Ed Tobias

Hi Paul,

Thanks for taking the time to comment and I'm glad that what I write is useful to you. That makes my day.

Not being a medical professional I have to assume that your neuro has read the research and believes, as many seem to believe, that some protection is better than none. It's interesting that you ask about the antibodies. I heard this very question asked on one of the cable networks just a day or two ago. The answer the guest neuro gave was that there are simple procedures to test for antibodies that are left behind by the COVID-19 infection. However, the tests for the antibodies created by the vaccines are not simple and are not available to the average person.

I think you were wise to have receive the vaccine. You're very wise not to lower your guard.

As for the weather, it's been sunny and around 90 degrees, but the humidity has been low with a nice afternoon breeze. Not good if you're a firefighter concerned with brush fires but great for exercising in the pool.

DeAnna Lopes

Hi,

I am taking
4-Aminopyridine after successful HSCT using chemo to kill the lymphocytes that held the m.s. memory. I am doing great and only take this medication because it helps me walk after 27 years with the MonSter.
I am scared to get the vaccine because I don't want to boost those lymphocytes and have m.s. back.

Yvette B

Hi,

I'm on Ocrevus and received the Janssen vaccine. While the mRNA vaccines primarily use B-cells in their process to create antibodies and provide protection, the vector vaccines primarily work with T-cells (helper) first and then involve B-cells later in the process. In theory, the adenovirus vaccine will help the body mount a response that, while attenuated, does provide some protection.

For me, my test came back negative for antibodies post-vaccination, but I've not had my T-cell levels tested. I'd be interested to know what that's looking like.

As far as testing, you can donate blood, plasma, platelets, etc., to see if you've developed antibodies either from being exposed to COVID-19 itself or from vaccination, but it will only tell you whether antibodies are present, not what the levels are.

The only test available to measure the actual levels is administered at one hospital in New Jersey under an FDA EUA. Here's hoping that the test will become available in more places so we can get all of the information and be as accurate as possible.

In the meantime, we keep reading the studies and reports, keep asking questions of the professionals, keep sharing our anecdotal experiences, and keep helping each other.

Ed Tobias

Hi Yvette,

Thanks for taking the time to provide that information. It adds a lot to the conversation.

I wish you success with both Ocrevus and the Janssen vaccine.

Faige Glasomitsky

Timed my vaccines 3 months after my Ocravus treatment. Don't know if I developed any antibodies, but I'm scheduled to check when I get my next treatment at Hadassah, as part of THEIR study about MS treatments and vaccine efficacy. Meanwhile, we Israelis have our hands full just to avoid getting hit by a missile. Best regards from Jerusalem!!? ? ?

Ed Tobias

Hi Faige,

Thanks for the information. I hope you've developed those antibodies and I'll be very interested to learn the results of your next tests at Hadassah, if you're willing to share with us.

Yes, your hands are full, to say the least. I hope you're able to stay safe.

Kristi

How effective is Pfizer if you are taking Copaxone?

Ed Tobias

Kristi,

Copaxone wasn't included in this study. I'm not aware of any study that has included it.

Margaret

Is there any information about the efficiency of the Pfizer vaccine if you are on Copaxone 20 mg?

Ed Tobias

Margaret,

This study only included the medications mentioned in my column. Copaxone wasn't included.

Margaret

Ed, Thank you for letting me know. I hope at some point other MS drugs will be studied like the ones in your column.

Ed Tobias

Margaret,

I think as scientists continue to learn more about COVID-19 there will be more studies and we'll know more about the other DMTs. But, the MS associations are recommending people be vaccinated no matter what DMT they're using. Just keep your neurologist in the loop.

Margaret

I totally agree. I am 100% vaccinated. :-)

Ed Tobias

Bravo, Margaret!

Monoclonal antibody cocktails have been found to be safe and over 80% effective as a prophylaxis against covid. MS patients and other people dealing with autoimmune disease, cancer or transplants are being left behind. Why hasn't the FDA authorized this to provide protection to those whose vaccination responses are potentially diminished or ineffective due to their treatment? Where is the national MS organization on this issue?

Ed Tobias

To be clear, monocolonal antibody medications are being used, successfully, to treat people who have been diagnosed with COVID-19...not as vaccines that can prevent it. The FDA has approved a few of them. The most recent approval was issued just a few days ago:
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-monoclonal-antibody-treatment-covid-19

I understand your reply, Ed, and I thank you for responding. However, my point is that dllarge, double blind, placebo controlled studies have indeed found that monoclonal antibody cocktail has been found safe and effective as a prophylaxis,and therefore should be made available for those that potentially have poor (or no) vaccine response due to the anti b cell medication. My point is that the need is quiten pressing.
https://investor.regeneron.com/news-releases/news-release-details/phase-3-prevention-trial-showed-81-reduced-risk-symptomatic-sars

Thanks for your reply, Ed. My point, however, is that a Regeneron monoclonal antibody cocktail has also been studied as a prophylaxis to prevent coronavirus infection, and was found to be 81% effective in a large randomized, double blind, placebo controlled trial. This could be an extremely effective tool to protect people on anti-cd20 medications (and others) that blunt and/or render covid vaccines ineffective. I believe that pressure should be placed on policymakers to authorize this so the many, many people potentially without protection can regain a semblance of normalcy.

Ankit

Do these vaccines increase MS relapse risk or long term disease progression? For me, that's the highest concern I have since I want my MS to not aggravate due to these. Please advise.

Ed Tobias

Hi Ankit,

This study only looked at one vaccine and didn't report anything about MS. However, from what I've read there is no indication the COVID vaccines impact MS progression and the only impact on relapses is that the temporary fever the vaccines may cause could result in a pseudo-relapse...one that ends when the fever disappears.

Jordana

I am taking Gilenya, and had the Moderna vaccine.
Should I be concerned? Should I get tested for antibodies?

Ed Tobias

Hi Jordana,

The US National MS Society says this about Gilenya and similar phosphate receptor modulators:
"If you are about to start one of these medicines, consider getting fully vaccinated* 2-4 weeks or more prior to starting your medicine. If you are already taking Gilenya, Mayzent, Zeposia or Ponvory, continue taking as prescribed and get vaccinated as soon as the vaccine is available to you."

You'd have to get tested for antibodies through your doctor so it's best to ask him that question. I, however, don't see a reason to get the test.

Robyn

Hi Ed,
I too was treated with Lemtrada. I received the Pfizer-BioNTech vaccine. In a couple of weeks, I will celebrate the end of the monthly tests because it will have been 5 years since my second treatment. When COVID struck, my CD4 count had just broken 300 and I was very concerned. So, I went back into my Lemtrada bubble and limited interaction with the outside world.

My neuro has already told me that if my MRIs show new plaques, he will want me to go back on a DMT (so much for the promise that I wouldn't need DMTs after Lemtrada). Because my JCV number is very high, all of the PML risk DMTs are out. Because he believes that we will need COVID boosters in the future, he bumped Ocrevus from the potential list of DMTs for me to reject leaving only Mavenclad and Abagio as choices.

Ed Tobias

Hi Robyn,

I'm sorry for the delayed post approval and response.

Congrats on the end of the monthly Lem lab tests. I'm still a few months shy of that and will be very glad when they end. They can be a real pain to do but I also know how important they are so I was very strict about following them.

Prior to Lemtrada I was treated with Aubagio. It seemed to do ok at slowing my progression but I think Lemtrada worked better.

I guess you know that all of the most effective DMTs carry a risk of something. You don't mention Kesimpta, which was approved a little less than a year ago. Like Ocrevus it attacks B cells, but it's an injection. I suppose, however, your neuro would rule it out because of COVID concerns.

I'm done with DMTs. After living with MS for 40 years, and as I approach my 73rd birthday, I think I've done all the treating that I'm gonna do.

Good luck to you,

Judith Wardle

Congratulations and happy birthday Ed. I was diagnosed 30 yrs ago, been thru injections, infusions, different pills. Have been on Aubagio for several years. Johns Hopkins is currently enrolling in study of efficacy of vaccines for transplant patients and patients w/chronic diseases. They test blood samples after 1st shot, after 2nd shot and on schedule for a year - National Vaccine Research Study for Transplant Recipients and Patients with Chronic Diseases. Hope it will provide good news.

Ed Tobias

Hi Judith,

Thanks for this info. I was unaware of this study and will try to remember to check it out.

Lisa

Hi Ed, I have been off DMT for several years because I was always getting infections. I got the moderna vaccine. My Neurologjdt sants me to go back on DMT Ocevus again in the middle of a pandemic. I went to my primary care doctor who tested my immunoglobulin levels which were low and advised me to wait if I could. I know I don’t respond well to vaccines. Was tested several years ago after receiving prevnar 13 vaccine and was only protected from 3 of the 2: strains of pneumonia. I’m very concerned about whether the moderna vaccine gave me any protection. When is the government going to care about the immune compromised population. There are a lot of us. Why get vaccines if it doesn’t work. I’m frustrated. Thank you.

Ed Tobias

Hi Lisa,

From what I've read, the COVID-19 vaccines provide some level of protection, even for people on DMTs that affect the immune system. I received the Moderna vaccine and I believe that I have a high level of protection, even though I was treated with Lemtrada. Of course, that treatment was a few years ago. In my personal opinion, as someone who is not a healthcare professional, I'd follow your neuro's recommendation and go back on Ocrevus. Doing that would seem to be the best of both worlds. Some protection from COVID and from MS.

Ellen B

Hi Ed!
I had my 2nd Pfizer vaccine 3 1/2 weeks before my last Ocrevus infusion in May. My neuro tested me last week and found I didn’t have any COVID antibodies. I feel blessed I didn’t get it COVID while not knowing I wasn't protected. We were at Disney World in the heat and large crowds just few weeks ago.

Ed Tobias

Hi Ellen,

I'm certainly glad that you've escaped COVID-19 but, as I understand it, a negative antibody test doesn't necessarily mean you don't have any protection. I wrote about this back in June. Note that the FDA says “antibody tests should not be used at this time to determine immunity or protection against COVID-19 at any time, and especially after a person has received a COVID-19 vaccination.”

Here's the column: http://multiplesclerosisnewstoday.com/columns/2021/06/15/my-covid-19-antibody-report/

Cam

I had the Pfizer vaccine while on Gilenya back in Feb.. My Neuro wants me to switch to Zeposia and mentioned he might want me re-vaccinated. HE referenced this article and the findings. Have you heard about this scenario? getting vaccinated AGAIN?

Ed Tobias

Hi Cam,

The study I wrote about in this column didn't mention Zeposia and I've not heard any discussion of a re-vaccination. However, I'm not a doctor and your neuro may have information that I've not seen.

ben rickey

Around 5+ years of Gilenya.
MS for 34+ years.
Went 13 years with an exacerbation, though damage continued to occur.

SARS CoV 2 SEROLOGY (COVID19) AB (IgG,IgM), IA: negative

SARS COV 2 SEROLOGY (COVID 19) AB (IGM),IA: negative

Pfizer vaccine.
Around 6 weeks after second dose of Covid-19.
No significant reaction to Covid -19 vaccine.
Titer checked 6 weeks post second dose.
I also get typical cold symptoms without neuro involvement.
Doc is investigating if another dose of Covid-19 vaccine is warranted.
Not holding my breath.
There is not a vaccine for "common cold" (typically a rhino virus disease).
It is NOT a stable virus.
Not the 'wander' in Covid-19.

Ursula Doyle

I am on Beta Interferon injection 3 times a week for the last 23years and I got the 2 shots of the Pfizer vaccine
I stopped taking it about a month before I got 1st vaccine and stayed off it until about a month after 2nd vaccine
I am trying to get back into taking the beta interferon but I am feeling really rough aches pains in my joints, headaches, sweating nearly all the time, I wonder is it the beta interferon is causing this or is it the Pfizer one that is causing this. Do you know anything about this? Is this reaction normal? I dread doing my Beta Interferon injection now I know I feel horrible each time I do it. Can you help in anyway?

Ed Tobias

Hi Ursula,

I'm afraid your question is out of my league, since I'm not a medical professional. I'd suggest you speak with your neurologist about this. At the same time, you might let that doctor know how you feel about having injected yourself for two decades. I lasted only six or seven years before I got needle fatigue. There are now more than 20 disease-modifying treatments...some of which are pills. Why not ask the doctor about other choices?

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Efficacy of Pfizer-BioNTech COVID-19 Vaccine Varies by DMT, Study Finds