Remaining questions regarding COVID-19 vaccines in MS

WATCHING TIME: 4 minutes

For more coverage of WCSC 2022, click here. A transcript of the conversation is below.

Matt Hoffmann: So, obviously, a very happy discovery. Fortunately, we have no major concerns in terms of antibody response. But on that note, you know, based on what’s been gathered so far and what’s been analyzed, have there been any concerns raised? I know, again, we mentioned those very small subsets of patients where the response wasn’t ideal, but it’s hard to draw conclusions. But anything, if not disturbing, perhaps surprising?

Daniel Kantor, MD: I think there are three questions left for the community. There are many more questions. But there are a few main questions. One question is about B-cell depleters. If you take a B-cell depletor, what does that mean, not only in terms of COVID-19 risk, but also vaccine response? We’re starting to hear from different places, we’ve already had an idea that the immunoglobulin response isn’t that good, and there’s emerging data that the T cell response may not be as bad as we thought so. That’s exciting.

Then the other question is, and looking specifically at the legacy S1P receptor modulator, looking at fingolimod (Gilenya; Novartis), does it have a protective response or not? The third question is: is the new class of more selective S1P receptors different from fingolimod in any way? I suspect we’re going to find study after study – remember, these little things seem to be confirmed and other people’s studies in other parts of the world and larger data sets – which may be a narrow answer for the fingolimod, but we’re still going to see good antibody as well as T cell response for newer agents like ozanimod.

Matt Hoffman: Some questions remain unanswered at the end, and more research still needs to be done. But for you, then, to conclude and salute the clinical community, what are the takeaways? What should they take away from this GFCS presentation with in their pocket?

Daniel Kantor, MD: Well, one thing they should walk away with is that maybe the older S1P receptor modulator, fingolimod, which we’ve had since 2010, is different from the newer agents we have. I think we need to look at this more carefully. We just have to stop saying, “Well, they’re not selective or they’re selective, and that’s it.” I think we need to take a closer look at the different S1P, or sphingosine 1 phosphate receptors, and understand how they might be different and how they might have different effects in the body. Not only the effect on lymphocytes, but also the effect on neurons, as well as supporting cells inside the central nervous system. We will therefore focus on this question.

Then I think our other question is really, well, let’s look at these more selective S1P receptor modulators, like ozanimod, and it looks like we can reassure our patients that they’ll still have the vaccine response. But I want to put all of this on hold because for all patients, whether they have multiple sclerosis or not, vaccines work. But, then it seems like they fade in response. I mean, we’re hearing now about data that’s for kids – not with multiple sclerosis – over 6 months, where they’re going to have to get one shot, the second shot and the third shot, and then they’re still not protected only for 6 months. I think we have to realize that the vaccine is part of controlling this pandemic. We must also consider other means. How do we treat people? How do we treat people in low-resource countries? If a country has resource problems and does not get sophisticated monoclonal antibodies, what other types of treatments [can they get]? I think the community did a good job there. I think, unfortunately, it’s become very politicized and because it’s become very politicized, with treatments that might make sense, people say, ‘Oh, that sounds crazy’ or ‘you used it’s off-label.” I think we all know that we all use off-label drugs rationally all the time. We explain to patients the benefits and the risks.

Matt Hoffmann: Absolutely. Thank you very much for sitting with me today.

Transcript edited for clarity.

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