Family Planning and Vaccination Considerations for Patients With MS

EP: 1.Multiple Sclerosis and Pregnancy Misconceptions

EP: 2.Considerations and Resources for Pregnant Patients With MS

EP: 3.Treatment Selection in MS and Pregnancy

EP: 4.S1P Receptor Modulator Therapy Reversibility Considerations

EP: 5.Postpartum Relapse in Patients With MS

EP: 6.Clinical Trial Considerations for Ethnically Diverse, Underrepresented MS Patients

EP: 7.Fostering Patient-Centered Care in Ethnically Diverse, Underrepresented MS Patients

EP: 8.Building Trust in Ethnically Diverse and Underrepresented MS Patients

EP: 9.Patient Education in Ethnically Diverse and Underrepresented MS Patients

EP: 10.Surgical Considerations for Patients With MS

EP: 11.Considerations for Infection Risk in Patients With MS

EP: 12.Immunogenicity and Disease-Modifying Therapies

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EP: 13.Family Planning and Vaccination Considerations for Patients With MS

EP: 14.The Benefits of Collaborative Care for Patients With MS

EP: 15.Tools and Resources for the Management of MS

Jeffrey Dunn, MD: Dr Berkovich, could you discuss your approach to starting or stopping DMTs [disease-modifying therapies] and patients because of family planning reasons or vaccination?Let’s start with family planning.

Regina Berkovich, MD, PhD: With the family planning, I’ve had negative experiences with some patients who were stopping DMTs in order to get pregnant, and then somehow wouldn’t get pregnant during a year or 2 or even 3 years, and then end up with relapses. That would even more delay the plan of getting pregnant. I no longer recommend stopping DMTs because of family planning. What I would do, though, is switch to the DMT that has a better report when it comes to the pregnancies. That’s No. 1. What was the second question you had?

Jeffrey Dunn, MD: On vaccination.

Regina Berkovich, MD, PhD: We know that with the majority of DMTs, the live vaccines, if they’re contemplated, should be done before starting the particular medication. That’s something I would reiterate. If someone is planning to travel to Africa or India for example, tell me ahead of time and get those vaccines before you go on certain medications. But if it comes to antiviral vaccines, we don’t have much evidence. For the flu vaccine or COVID-19 vaccine, we don’t have a specific recommendation there. That’s open to interpretation, and different experts may have different opinions, but with the lack of evidence, I’d decide it on individual basis.

Jeffrey Dunn, MD: Some of our patients are opting to hold medication until a vaccination is given to allow it to be fully potent and then start a medication later. Is that a practice that you condone or support, or does that weigh into your choice of DMT?

Regina Berkovich, MD, PhD: I don’t think we have enough evidence to support that approach. If there’s evidence and I’m not aware of it, I’ll be happy to learn. My opinion is that in the mRNA vaccines and flu vaccines, we don’t have much data to say 1 way or another.

Transcript Edited for Clarity