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MS Blog & Podcast

Nov 27 2021 COVID-19 & MS Treatment: The Long Game

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Omicron variant of the SARS-CoV-2 virus that causes COVID-19 is now taking off in South Africa with scattered cases already in Europe. With over 30 mutations to the spike protein on the surface of the virus, unanswered questions arise. Will the vaccines still be protective? Is this version of the virus more infectious and more lethal? Africa was vulnerable due to only 6% of the population being vaccinated due to global health disparities.

People living with multiple sclerosis deserve highly-effective therapy, which has been shown to prevent future physical and cognitive disability. Many of these medications that prevent the autoimmune attack on the brain and cervical spine are immunosuppressive. Under normal circumstances, the benefits generally outweigh the risks.  During the COVID-19 pandemic, individuals on immunosuppressive MS disease-modifying therapies have had to be extra careful to avoid infection and may be at risk for more serious COVID-19. It’s been a substantial sacrifice for them; missing out on some family gatherings, limited time with friends, remote work or high-risk exposure at work and avoiding critical exercise at classes, gym or the pool. Anxiety and depression in the MS community has been very high during the pandemic.

Sacrifice for 2 years is hard enough, but what if COVID-19 doesn’t go away? COVID-19 could stay around as an “endemic” disease. The best case scenario is that enough people become vaccinated (with regular boosters) or infected naturally that there will be a dramatic decrease in cases over the coming years. An influenza A virus H1N1 caused the 1918 Spanish flu, killing 50 million people globally. Influenza viruses are still around, resulting in 20-60,000 American deaths annually.  However, flu vaccines are not nearly as protective as COVID-19 vaccines and new and emerging treatments for COVID-19 are quite effective.

At some point, each person with multiple sclerosis will need to make a calculated decision with their healthcare providers about their future treatment strategy. I anticipate most people would rather adapt their lifestyle so they can continue on highly effective treatment to prevent future physical and cognitive impairment. Other people living with multiple sclerosis may prefer de-escalation of treatment, using a medication that may be less effective but less or not immunosuppressive. Induction therapy might also become more attractive with temporary immunosuppression followed by “rebooting” the immune system such as with Mavenclad or Lemtrada.  Risk factors for worse COVID-19 disease will need to be considered such as older age and other medical problems like hypertension.

The bottom line:  We will get through this challenging time together as a MS community with open communication between those of you living with multiple sclerosis and the healthcare professionals that show up in a mask everyday to care for you.

Oct 14 2021 MS Living Well Podcast: Multiple Sclerosis Clinical Trials

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Interested in improving MS care? Participating in a clinical trial may have personal advantages and may help others in the future. Trial design discussed including whether or not a placebo (no treatment) will be used. Criteria needed to enroll in a clinical study called inclusion and exclusion criteria explained. Key elements of clinical trials outlined including multiple safety measures and informed consent.

Current clinical trials in multiple sclerosis are covered including using highly effective treatment early for someone living with multiple sclerosis. Current studies in progressive MS and remyelination shared. Compounds highlighted include BTK inhibitors, masitinib, ibudilast, simvastatin and gold nanocrystals.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Jiwon Oh MD PhD

Jiwon Oh MD PhD is the Director of the BARLO MS Centre at St. Michael’s Hospital in Toronto. She is an Associate Professor of Neurology University of Toronto. Dr. Oh’s research focuses on developing advanced imaging techniques of the spinal cord and brain for use in clinical settings. She is the principal investigator  of local and collaborative, multi-center MRI studies. Dr. Oh is the lead of the Canadian National Progression Cohort, which is focused on better understanding progression in MS.  She completed her undergraduate degree at the University of Toronto and medical school from Queen’s University. Dr. Oh completed her residency at the University of Toronto, PhD in Public Health at John Hopkins and neuroimmunology fellowship at John Hopkins.

Robert Bermel MD

Robert Bermel MD is a neurologist specializing in multiple sclerosis at the Mellen Center for Multiple Sclerosis at Cleveland Clinic. He received a medical degree with thesis honors from the State University of New York at Buffalo. Dr. Bermel completed his neurology residency training and served as Chief Resident at Cleveland Clinic. He was funded as a National MS Society postdoctoral fellow in clinical neuroimmunology and advanced imaging at Cleveland Clinic. Dr. Bermel cares for patients, conducts imaging research, and an investigator in multiple clinical trials at the Mellen Center. His current research interests focus on the identification of advanced imaging methods to evaluate and improve recovery from inflammatory demyelinating disease.

This specific episode is sponsored by Sanofi Genzyme.

 

Apr 6 2021 MS Living Well Podcast: Future Look: From Diagnosis to Tracking Multiple Sclerosis

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Cutting-edge research is revolutionizing how multiple sclerosis is diagnosed and monitored.  The central vein sign on MRI may soon be a key way of confirming if someone has multiple sclerosis versus other conditions such as migraine, vasculitis, neurosarcoidosis and blockage of small blood vessels (from age, smoking and hypertension).

Multiple sclerosis lesions with visible dark veins inside, called Central Vein Sign. Image: Daniel Reich MD PhD

Early clues on MRI imaging are shared in people with evidence of MS prior to developing symptoms (called radiologically isolated syndrome or RIS). New imaging techniques in development visualize changes in progressive multiple sclerosis like slowly-expanding lesions and inflammatory cells called microglia.  Dr. Daniel Reich from the NIH covers additional topics from routine MRI monitoring of the brain and spinal cord to remyelination imaging.

With incredible medical advances, some people that were considered to have multiple sclerosis are now diagnosed with neuromyelitis optica (NMO) and MOG Antibody Disease (MOGAD).  Dr. Sean Pittock from Mayo Clinic shares how NMO and MOGAD are different from multiple sclerosis and reviews the alternate approaches to treatment including the 3 FDA-approved treatments for NMO, Soliris (eculizumab), Uplinza (inebilizumab) and Enspyrng (satralizumab).  Latest research in screening spinal fluid and blood for clues of multiple sclerosis discussed to improve diagnosis and monitoring of the disease.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Daniel Reich MD PhD

Daniel Reich MD PhD is the Chief of the Translational Neuroradiology Section of the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH).  He obtained his undergraduate degree in math and physics at Yale, PhD in neuroscience at The Rockefeller University and MD degree at Cornell.  Dr. Reich completed residencies in both neurology and diagnostic radiology and a neuroradiology fellowship at John Hopkins Hospital.

Sean Pittock MD

Sean Pittock MD is a Professor of Neurology at Mayo Clinic.  His is the Director of Mayo Clinic’s Center for Multiple Sclerosis and Autoimmune Neurology and Director of Mayo’s Neuroimmunology Research Laboratory. He earned his medical degree from University College Dublin, post-doctoral degree at the Royal College of Surgeons in Ireland followed by residency and fellowship at Mayo Clinic in Rochester, Minnesota.

Mar 23 2021 MS Living Well Podcast: Wellness & Multiple Sclerosis

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Wellness is a proactive approach to living with multiple sclerosis. Wellness complements routine neurological care, which is often reactive to new relapses, symptoms and disease progression.  Nutrition reviewed including diets such as intermittent fasting, paleo and Wahls Protocol.  Great physical health relies on keeping up with routine cancer screenings and vaccinations. Options for protecting cognitive health and improving mental health are highlighted. Ways to improve social and spiritual connections are shared.

Successful exercise strategies presented for an array of MS disability levels.  Information given on how to balance the need for increased muscle strength with concerns of overexertion and fatigue. The role of physical, occupational and speech therapy for people with MS reviewed.  The latest and future technology explored including zero-gravity treadmills, electronic foot braces, robotic exoskeletons and implantable microstimulators.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Riley Bove MD is an Assistant Professor of Neurology at the University of California-San Francisco.  Her multiple sclerosis research focuses on hormones and digital medicine. Dr. Bove started her studies in anthropology at Harvard and then global studies on a Fulbright scholarship. She returned to Harvard for medical school and then completed her residency at Massachusetts General Hospital and Brigham Women’s hospital in Boston.  She completed a clinical research fellowship at the Partners MS Center and a Masters Degree through Harvard Medical School’s Clinical Investigator Training Program.

Ben Thrower MD is the medical director of the Andrew C. Carlos MS Institute at Shepherd Center, a leading rehabilitation hospital in Atlanta. He completed his medical degree at University of Florida and neurology residency at the University of Texas in San Antonio. Dr. Thrower is a Clinical Instructor of Neurology at Emory University and participates actively in clinical research. He serves on the board of directors of the Georgia Chapter of the National MS Society and has served on the board for the Consortium of Multiple Sclerosis Centers. In 2005, he was the first physician inductee into the Georgia Chapter of the National MS Society Volunteer Hall of Fame.

Mar 19 2021 Ponvory (ponesimod) FDA approved!

Ponvory (ponesimod) is an oral S1P1 medication which traps certain causes types of lymphocytes (a type of white blood cell) in lymph nodes and keeps them out of the brain and spinal cord.  In the OPTIMUM multicenter, double-blind trial, 1133 relapsing multiple sclerosis patients were randomized to Ponvory or Aubagio oral medication daily.  Relapses were 30.5% lower on Ponvory than Augabio.  New lesions were reduced by 56% on Ponvory compared to Auabigo.  No statistically significant difference was seen on disability progression on the 2 medications.

Risks that were higher on Ponvory than Aubagio in clinical trial included high liver blood tests, nasopharyngitis, upper respiratory infections, respiratory symptoms and increased blood pressure.  This class of medications has been associated with rare serious infections including PML and cryptococcal meningitis.  In clinical trial, the dose was increased to full dose of 20 mg over 2 weeks to reduce risk of slowing heart rate or irregular heart rate with first dose.

Mar 9 2021 MS Living Well Podcast: Anxiety, Depression & Multiple Sclerosis

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Struggling with anxiety or depression? Over half of people living with multiple sclerosis can experience depression and up to 40% have anxiety. Both psychological and physical symptoms that people with MS experience are explained. Causes for these mood disorders are discussed including immune inflammation in the brain, adaptation to having a chronic disease and medication side effects such as interferons and steroids.  People with depression are at higher rate of developing multiple sclerosis. In addition, depression is associated with more disability for those living with MS which may be due to not taking medications properly, smoking, not exercising and even chemical brain changes.

Therapy options explored including meditation (including mindfulness), stress reduction, cognitive behavioral therapy and virtual platforms. Prescription medication options for both anxiety and depression covered including benefits and risks including dependence. Experts share resources and hope for those living with MS with severe depression including suicidal thoughts.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Amy Sullivan PsyD ABPP

Amy Sullivan PsyD, ABPP is a board-certified, staff clinical health psychologist and the Director of Behavioral Medicine at the Mellen Center for MS Treatment and Research at the Cleveland Clinic. Dr. Sullivan received her doctorate degree at Argosy University-Atlanta, her internship at the University of Cincinnati, and her fellowship at the Cleveland Clinic in Pain Medicine. She is also the principal investigator for several clinical trials at the Mellen Center, where her research interests are focused on MS, pain, exercise and behavioral medicine.

Adam Kaplin MD PhD

Adam Kaplin MD PhD is the Chief Scientific Officer of MyMD Pharmaceuticals Inc. since December 2020.  He completed his undergraduate degree from Yale University, graduating magna cum laude, and obtained both his MD and PhD degrees at Johns Hopkins. Dr. Kaplin complete his residency in psychiatry at Johns Hopkins Hospital, where he served as the chief resident of psychiatry. He served as an Assistant Professor of Psychiatry and Behavioral Sciences at John Hopkins and the principal psychiatric consultant to the John Hopkins MS Center. He remains as adjunct faculty at John Hopkins.

Feb 23 2021 MS Living Well Podcast: Progressive Multiple Sclerosis

Mark Webb, wheelchair rugby player and Head of Communications for Shift.ms

Progressive multiple sclerosis can be a worrisome diagnosis, filled with questions about one’s personal future including independence. In this podcast, Mark Webb shares his personal story of transition to secondary progressive multiple sclerosis with brilliant humor, incredible resiliency and tenacious optimism. He explains how MS has affected his career from Euro Disney to Head of Communications at Shift.ms, a global online MS community. He candidly describes the impact of the disease on his functioning including cognition, mobility and bladder and how he has adapted to these obstacles. Mark reflects on his acceptance of progressive MS and emphasizes his motivation to make a difference for himself, his family and the MS community.

Dr. Gavin Giovannoni describes in the podcast primary progressive MS (PPMS), secondary progressive MS (SPMS) and active secondary progressive MS and whether or not these are truly different conditions. He moves beyond labels and explains that people with progressive disease, even those with limited mobility, can still be at risk of relapses affecting vision and arms. Continuing, switching or stopping disease-modifying therapy in progressive multiple sclerosis patients are covered. The impact of early MS damage, aging and ongoing, smoldering inflammation on progressive disease is described. Progressive multiple sclerosis treatments in clinical trials are highlighted including masitinib, BTK inhibitors, ibudilast, simvastatin, biotin, lipoic acid and remyelination strategies.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Mark Webb

Mark Webb is Head of Communications for Shift.ms, an online community of over 38,000 people living with MS. Mark lives with secondary progressive multiple sclerosis and first developed MS symptoms back in 1992. He’s a blog writer: One Man and His Catheters, public speaker and rugby wheelchair player. Mark lives in the U.K. with wife and 2 sons.

Dr. Gavin Giovannoni

Gavin Giovannoni MBBCh, PhD, FCP, FRCP, FRCPath is the Chair of Neurology of the Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry at Queen Mary University of London. Professor Giovannoni completed his medical training and neurology training in South Africa. In addition, he completed a PhD in immunology from the University of London in 1998.  He is particularly interested in clinical issues related to optimizing MS disease modifying therapies including progressive disease.

Feb 9 2021 MS Living Well Podcast: Multiple Sclerosis Numbness & Pain: Relief Options

Photo: Rafal Szczawinski on Unsplash

People living with multiple sclerosis often experience chronic numbness, burning, tingling and pins-and-needles sensations.  In a recent study, 70% of people with MS reported numbness and tingling and 55% reported pain associated with relapses.  MS neurologists explain typical symptoms for brain and spinal cord MS attacks compared to a pinched nerve in the back (like sciatica) or neuropathy.  Lhermitte’s sign (shocks down the spine when moving neck) and Uhthoff’s phenomenon (symptoms like numbness when overheated) are covered since frequently the first symptoms of multiple sclerosis. Options for relief from burning, tingling and pins-and-needles reviewed including medications such as Neurontin (gabapentin), Lyrica (pregabalin), Elavil (amitriptyline) and Cymbalta (duloxetine).

Painful MS syndromes including trigeminal neuralgia, MS hug and flexor and extensor spasms are individually reviewed with numerous specific treatment options.  MS experts also share options to alleviate painful muscle cramps and spasms as well as musculoskeletal pain such as low back pain.  The podcast aims to provide awareness and options for relief so that people living with MS can better communicate with their doctors to improve their care.

Barry Singer MD, director of The MS Center for Innovations in Care, interviews:

Mitzi Joi Williams MD

Mitzi Joi Williams, MD is the Founder and CEO of Joi Life Wellness Group Multiple Sclerosis Center.  She completed her undergraduate degree in neuroscience and behavioral biology at Emory University and her medical degree at Morehouse School of Medicine in Atlanta, Georgia.  Dr.  Williams subsequently did her neurology residency (including serving as chief resident) and multiple sclerosis fellowship at Georgia Health Sciences University (formerly MCG) in Augusta, GA.  She is the author of MS Made Simple: The Essential Guide to Understanding Your Multiple Sclerosis Diagnosis.

Brandon Beaber MD

Brandon Beaber MD is a neurologist specializing in multiple sclerosis at Kaiser Permanente in Los Angeles.  He completed his undergraduate degree from University of California-Berkley followed by Medical School at Drexel University in Philadelphia. He completed his neurology residency at Kaiser Permanente’s Los Angeles Medical Center (LAMC) and fellowship in multiple sclerosis and neuroimmunology at University of Southern California.  He authored Resilience in the Face of Multiple Sclerosis and regularly posts educational videos for people living with MS on his YouTube channel.

Jan 26 2021 MS Living Well Podcast: Multiple Sclerosis & Vaccines including COVID-19

Barry Singer MD, MS Living Well podcast host, receiving 1st Pfizer COVID-19 vaccination on December 17, 2020.

Vaccinations have been extremely effective in saving people from numerous fatal diseases such as measles, polio, hepatitis B, diphtheria and tetanus. Currently, the COVID-19 pandemic has been raging with almost 100 million people affected and over 2.1 million people dead. We again turn to our medical researchers. Recently available COVID-19 vaccines provide new optimism.  People living with multiple sclerosis have numerous questions regarding whether these COVID-19 vaccines against the SARS-Cov-2 virus are safe and effective for them. Both mRNA and adenovirus COVID-19 vaccines are explained on this podcast and concerns regarding vaccinating MS patients addressed.

The podcast covers types of vaccines people with multiple sclerosis should avoid and which vaccines are safe. The question whether vaccines can trigger MS attacks is tackled. Vaccines for measles-mumps-rubella (MMR), chicken pox (varicella), hepatitis B and influenza (flu) are individually reviewed.  Multiple sclerosis disease-modifying therapies (DMTs) can suppress the immune system and potentially impact whether a vaccine will be protective or not. Existing info on each MS medication type is discussed. Timing of vaccinations and medication dosing strategies covered such as for Ocrevus (ocrelizumab), Lemtrada (alemtuzumab) and Mavenclad (cladribine). Vaccines as a strategy to prevent or treat multiple sclerosis are explored; Epstein-Barr virus and BioNTech’s mRNA vaccine are considered.

Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:

Dr. Anne Cross          Photo: Matt Miller

Anne Cross MD is Professor of Neurology at Washington University in St. Louis and Dr. John Trotter MS Chair in Neuroimmunology. She did her neurology residency at George Washington University and multiple fellowships including at the Neuroimmunology Branch at NIH, at the Department of Virology/Molecular Biology at St. Jude Children’s Research Hospital in Memphis and in the Neuropathology Department at Albert Einstein College of Medicine in New York.  Her leading work in B cells in multiple sclerosis was recently recognized with the 2019 John Dystel Prize for MS Research.

Dr. Amit Bar-Or

Amit Bar-Or MD, FRCP, FAAN, FANA is Professor of Neurology at University of Pennsylvania Perelman School of Medicine.   He serves as Director of the Center for Neuroinflammation and Neurotherapeutics and Chief of the Division of Multiple Sclerosis and Related Disorders. He completed his undergraduate degree at McMaster in Hamilton, Ontario, Canada and medical degree from McGill University in Montreal, Canada. His neurology training was at Massachusetts General Hospital and fellowship at Brigham and Women’s Hospital, both Harvard Medical School programs.  Dr. Bar-Or’s research focuses on neuroimmune health and central nervous system inflammatory diseases across the age span. He runs a cellular and molecular neuroimmunology lab studying principles of immune regulation and immune-neural interaction in the context of injury and repair of the human central nervous system.

Nov 28 2020 Does my MS medication affect my ability to respond to vaccines?

Image: Fusion Medical Animation on Unsplash

Background:

Our immune system includes a type of cell called lymphocytes. T lymphocytes target other cells such as cells infected with viruses or cancerous cells. They are called “T” cells since they mature in the thymus gland in the upper chest. Normally T cells that would attack our own cells are destroyed in the thymus gland before being released into the circulation. In autoimmune diseases such as multiple sclerosis, these T cells escape and can lead to the immune attack on myelin.

B cells mature in the bone marrow in humans, but were named after a specialized organ where B cells mature in birds known as the bursa of Fabricius. B cells can change into plasma cells which make antibodies. Antibodies are like targeted arrows that can help attack germs such as viruses or bacteria that are invading our bodies. In multiple sclerosis, B cells turn against their human by creating antibodies that attack myelin and revving up autoimmune T cells.

Role of T and B cells in Vaccination:

Vaccines work by imitating a serious infection. Vaccines can cause minor symptoms, but do not cause the actual disease. The vaccine triggers the development of specific-targeted T and B cells that remember the infection. When someone is then exposed to the real life-threatening virus or bacteria in the future, they can mount a highly effective defense against the infection due to these “memory” T and B cells. For example, children are vaccinated with a weakened, live chicken pox virus called the varicella-zoster virus. The immune system then develops T cells and antibodies specific for this varicella virus. The vaccine has been shown reduce the risk of getting chicken pox later in life by 92%. If someone is immunosuppressed, important to avoid live, weakened (attenuated) viruses.

Most vaccines are inactivated vaccines which means they do not contain live viruses or bacteria. Vaccines that inject killed whole virus include polio, hepatitis B and rabies.  Many inactivated vaccines include only sugar molecules (polysaccharides) that are found on the surface of bacteria or surface proteins that are found on viruses. These components of the infectious agent lack the ability to replicate since they do not contain disease-spreading genetic material (RNA or DNA).

COVID-19 vaccines:

For COVID-19, the Pfizer and Moderna vaccines are mRNA vaccines. The mRNA contains instructions for our own body to make a harmless “spike” protein.  This spike protein is on the surface of the COVID-19 virus. The spikes on the surface of this COVID-19 coronavirus creates a “corona” (derived from the latin word for crown).  The mRNA is surround by a lipid (fatty) nanoparticle that allows it to enter cells of the body when injected in the muscle.  Once mRNA is in the cells, the cells can create their own spike proteins on their surface. The body’s immune system that reacts to these foreign spike proteins leading to immunity with memory T and B cells.  These COVID-19 vaccinations result in a robust immune response to this spike protein that provides up to 95% immunity from the real COVID-19 infection, caused by the SARS-CoV-2 virus.

The AstraZeneca and Sputnik V vaccines use a type of virus called an adenovirus to insert DNA into the cell nucleus.  The double-stranded DNA does not get into our own DNA, however.  The DNA strand allows the cell to also make only the spike protein.  The DNA in the adenovirus has been altered so the adenovirus lacks to the ability to replicate (divide) in the body.

Disease-Modifying Therapies (DMTs) and Response to Vaccines:

All decisions regarding taking a vaccine with multiple sclerosis should be made in consultation with your healthcare providers.  

Multiple sclerosis medications can impact your body’s ability to mount an immune response to a vaccine. Most trials looking at responses to vaccines in MS patients measure antibodies in the blood which is driven by B cell immune response. You may be able to mount an effective T cell response to a virus, but much harder to measure. Different MS medications (DMTs) might weaken your ability to develop a protective level of immunity from a vaccine.  In a study of 152 people performed in Norway, protection against H1N1 flu virus at 6 months post-vaccination occurred in 86% of those MS patients treated with Copaxone (glatiramer acetate), 84% of patients on interferon, 58% on Gilenya (fingolimod) and 75% on Tysabri (natalizumab) and 94% of healthy people not on MS medications.

Live, weakened virus vaccines should be avoided on many multiple sclerosis DMTs including Ocrevus (ocrelizumab), Kesimpta (ofatumumab), Gilenya (fingolimod), Mayzent (siponimod), Zeposia (ozanimod) and Mavenclad (cladribine) per their prescribing information. At this point, the leading vaccines for COVID-19 do not contain live, replicating virus. The impact of each DMT on the protective response to COVID-19 vaccination is unknown. Both antibodies and T cell responses likely play a role in being fully vaccinated again the COVID-19 virus.

Below are some of the trials that have looked at vaccine responses to DMTs (Link for full review):

Aubagio (teriflunomide): The TERIVA trial examined flu vaccine responses to both Aubagio and interferon beta-1.  Effective vaccination based on antibodies was 97% to the flu-vaccine for H1N1 and B strains and 77% for H3N2.

Tecfidera (dimethyl fumarate): In another study of 71 MS patients (38 on Tecfidera and 33 on interferon), antibody response to specific pneumococcal strain vaccines was 84-95% on Tecfidera and 88-97% on interferon.  47% of MS patients on Tecfidera and 42% of patients on interferon made protective antibody levels at 4 weeks to a meningococcal vaccine.

Gilenya (fingolimod):  A trial of 138 MS patients randomized to placebo or Gilenya for 12 weeks to examine response to a seasonal flu vaccine.  54% of MS patients at 3 weeks after the flu vaccine mounted a protective antibody response on Gilenya while 85% on placebo.  At 6 weeks post-vaccination,  43% of Gilenya-treated patients made a response but 75% on placebo.

Interferons (class includes Avonex, Betaseron (Betaferon), Rebif, Extavia and Plegridy):  As above, the TERIVA trial examined flu vaccine responses to both interferon beta-1 and Aubagio. Effective flu vaccination based on antibodies occurred in 91-98% of multiple sclerosis patients depending on the flu strain.

Mayzent (sipinomod): Flu vaccination was studied prior to Mayzent treatment, during treatment and with treatment interruption in 120 healthy volunteers.  For Influenza A California strain,  protective antibody levels occurred in 86.7% of subjects on placebo, 92.9% vaccinated preceding Mayzent, 74.1% during Mayzent treatment and 71.4% with interrupted Mayzent treatment. For Influenza B Massachusetts strain, response rates were much less: 43.3% on placebo, 50.0% preceding, 25.9% during and 28.6% on interrupted Mayzent treatment.   100% of subjects immunized with pneumococcal vaccination prior or during Mayzent 2 mg treatment mounted protective antibody levels.

Ocrevus (ocrelizumab):  In the VELOCE trial, MS patients exposed to various vaccines were studied.  Flu-virus antibody responses were 56% to 80% on Ocrevus while 75-90% on placebo or interferon.  In addition, antibody response rates to pneumococcal vaccination was reduced.  Antibody (humeral) responses to vaccines rely on B cells and plasma cells.