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Review
. 2022 Feb 28:13:828616.
doi: 10.3389/fneur.2022.828616. eCollection 2022.

Vaccine Response in Patients With Multiple Sclerosis Receiving Teriflunomide

Carlo Tornatore  1 , Heinz Wiendl  2 , Alex L Lublin  3 , Svend S Geertsen  3 , Jeffrey Chavin  3 , Philippe Truffinet  4 , Amit Bar-Or  5
Affiliations
Review

Vaccine Response in Patients With Multiple Sclerosis Receiving Teriflunomide

Carlo Tornatore et al. Front Neurol. .

Abstract

Many patients with multiple sclerosis (MS) receive disease-modifying therapies (DMTs), such as teriflunomide, to reduce disease activity and slow progression. DMTs mediate their efficacy by modulating or suppressing the immune system, which might affect a patient's response to vaccination. As vaccines against the SARS-CoV-2 virus become available, questions have arisen around their efficacy and safety for patients with MS who are receiving DMTs. Data are beginning to emerge regarding the potential influence of certain DMTs on a patient's response to coronavirus disease 2019 (COVID-19) vaccines and are supported by evidence from vaccination studies of other pathogens. This review summarizes the available data on the response to vaccines in patients with MS who are receiving DMTs, with a focus on teriflunomide. It also provides an overview of the leading COVID-19 vaccines and current guidance around COVID-19 vaccination for patients with MS. Though few vaccination studies have been done for this patient population, teriflunomide appears to have minimal influence on the response to seasonal influenza vaccine. The evidence for other DMTs (e.g., fingolimod, glatiramer acetate) is less consistent: some studies suggest no effect of DMTs on vaccine response, whereas others show reduced vaccine efficacy. No unexpected safety signals have emerged in any vaccine study. Current guidance for patients with MS is to continue DMTs during COVID-19 vaccination, though adjusted timing of dosing for some DMTs may improve the vaccine response.

Keywords: COVID-19; disease-modifying therapies (DMTs); multiple sclerosis; teriflunomide (Aubagio); vaccination.

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Conflict of interest statement

CT reports receiving research support and honoraria for speaking or acting as a member of an advisory board or a Data and Safety Monitoring Board for Atara, Biogen, Celgene, Genentech, Sanofi Genzyme, and TG Therapeutics. HW reports receiving honoraria for acting as a member of scientific advisory boards for Biogen, Genzyme, Merck Serono, Novartis, Roche Pharma AG, Sanofi-Aventis, and UCB; speaker honoraria and travel support from Alexion, Biogen, Biologix, Cognomed, F. Hoffmann-La Roche Ltd., Gemeinnützige Hertie-Stiftung, Merck, Novartis, Roche Pharma AG, Sanofi Genzyme, TEVA, and WebMD Global; consulting fees from Actelion, Argenx, Biogen, Bristol Myers Squibb, EMD Serono, Idorsia, IGES, Immunic, Immunovant, Janssen, Johnson & Johnson, Novartis, Roche, Sanofi, the Swiss Multiple Sclerosis Society, and UCB; and research funding from the German Ministry for Education and Research (BMBF), Deutsche Forschungsgemeinschaft (DFG), Else Kröner Fresenius Foundation, Fresenius Foundation, the European Union, Hertie Foundation, NRW Ministry of Education and Research, Interdisciplinary Center for Clinical Studies (IZKF) Muenster and Biogen, GlaxoSmithKline, Roche Pharma AG, and Sanofi Genzyme. AL, SG, JC, and PT report receiving compensation as employees of Sanofi, and may hold shares and/or stock options in the company. AB-O reports receiving consulting fees from Accure, Atara Biotherapeutics, Biogen, BMS/Celgene/Receptos, GlaxoSmithKline, Gossamer, Janssen/Actelion, Medimmune, Merck/EMD Serono, Novartis, Roche/Genentech, and Sanofi Genzyme; and has received grant support to the University of Pennsylvania from Biogen Idec, Roche/Genentech, Merck/EMD Serono and Novartis.

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