A pilot study indicated that alemtuzumab is associated with normal responses to the meningococcus, pneumococcus, and diphtheria–pertussis–tetanus vaccines in most individuals. The vaccine did not work, however, if patients were vaccinated within several months of their treatment cycle. “The recommendation for alemtuzumab is that you either vaccinate before you give the therapy, or you wait at least six months after the treatment cycle,” said Dr. Coyle. If a neurologist vaccinates the patient six months after the treatment cycle, he or she should measure the patient’s antibody levels about a month later to confirm that the vaccine is working, she added.
Of all DMTs, fingolimod appears to have the most influence on a patient’s response to vaccination. The drug decreases the humoral response to the influenza, tetanus, and pneumococcal vaccines. Before initiating fingolimod, a neurologist should screen the patient for VZV antibodies. If the results are negative or show a low titer of VZV antibodies, neurologists may vaccinate the patient before starting fingolimod. Initiation of therapy should be delayed a month after completion of the vaccination, said Dr. Coyle. Patients taking fingolimod should not receive a live vaccine, and post treatment vaccination should be delayed until two months after the drug is stopped, she added
—Erik Greb