Regina Berkovich, MD, PhD, shares her approach on the initiation and cessation of treatment for patients with multiple sclerosis who are considering family planning and vaccinations.
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