Recent Update on the Oral Management of Relapsing Remitting Multiple Sclerosis (MS) - Episode 5
Dr Heidi Crayton reviews the potential impact of vaccinations on immunosuppressive disease-modifying therapy efficacy in patients with multiple sclerosis.
Heidi Crayton, MD: Mechanism of action has become even more of an issue in the past couple of years of the pandemic because we've seen response, or lack of response, to vaccines. We've all become bedside immunologists over the past couple of years in seeing how people respond to novel exposure. We've always known about getting the flu vaccine; most of the products on the market have data that shows that they have a response to flu vaccine or tetanus vaccine. But this was a bit of a different situation because COVID vaccination was something that we had not seen before. We were counting on immune system to mount a response, and a de novo response is something that had not been seen before. We saw changes that I don't think we were expecting. We knew that B cell–depleting therapies would probably result in a lower response to vaccination. We saw that the S1P [sphingosine 1 phosphate] receptor modulators also do that—maybe not to the same extent—and there's a small difference between the S1P receptor modulators in terms of their response with COVID vaccination. People who have been on products that are immunosuppressive—meaning ablating a certain cell type or sequestering a certain cell type—we've not necessarily thought of them as immunosuppressive, but in terms of not being able to mount a response to a novel exposure certainly puts them in that category. We've learned a lot about the mechanisms of action and the immune system's reaction to novel products in these past couple years.
Transcript Edited for Clarity