Remaining questions about COVID-19 vaccines in MS

WATCH TIME: 4 minutes

For more coverage of CMSC 2022, click hereA transcript of the conversation is below

Matt Hoffman: So, of course, a very happy finding. Fortunately, we have no major concerns in terms of antibody response. But based on what has been collected and analyzed so far, were there any concerns? I know, again, we mentioned these very small patient subgroups where the response was not ideal, but it was difficult to draw conclusions there. But was something, if not worrisome, perhaps surprising?

Daniel Kantor, physician: I think there are three more questions for the community. There are many more questions. But there are some key questions. One question is for B cell depleters. If you take a drug that breaks down B cells, what does that mean, not only in terms of the risk of COVID-19, but also the vaccine response? We’re starting to hear in different places, we’ve already had an idea that the immunoglobulin response isn’t as good, and there’s some new data that the T-cell response might not be as bad as we thought. So that’s exciting.

Then the other question, 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 newer class of more selective S1P receptors somehow different from fingolimod? I suspect from study after study – remember, this few seems to be confirmed and the studies of other people in other parts of the world and larger data sets – that may be a reduced response to fingolimod, but we’re still going a good antibody and T cell response to the newer agents such as ozanimod.

Matt Hoffman: Some questions eventually remain and some more research needs to be done. But for you, to round it off a bit and bow to the clinical community, what are the takeaways? What should they have with them for this presentation at CMSC?

Daniel Kantor, physician: Well, one thing they have to walk away with is that the old S1P receptor modulator, fingolimod, that we’ve had since 2010, may be different from the newer ones that we have. I think we should look at that more closely. We just have to stop saying, “Well, they’re either non-selective or they’re selective, and that’s all.” I think we need to look more carefully at the different S1P or sphingosine 1 phosphate receptors and understand how they can differ and how they can have different effects in the body. Not only the effect on the lymphocytes, but also the effect on the neurons, as well as the supporting cells in the central nervous system. So we’ll focus on that question.

Then I guess our other question is really, let’s take a look at these more selective S1P receptor modulators, like ozanimod, and it seems like we can reassure our patients that they’re still going to get the vaccine response. But I want to interrupt all of this for a moment, because for all patients, whether they have multiple sclerosis or not, the vaccines work. But then they seem to fade in response. I mean, we’re now hearing about data that has to do with kids — not multiple sclerosis — older than 6 months, where they have to get one vaccine, the second vaccine, and the third vaccine, and then they’re only protected for 6 months. I think we need to realize that vaccine is part of managing this pandemic. We also need to look at other ways. How do we deal with people? How do we deal with people in poor countries? If a country has problems with resources, and they’re not getting nice monoclonal antibodies, what other types of treatments? [can they get]† I think the council has done a good job there. I think unfortunately it has become very politicized and because it has become very politicized, with treatments that might make sense, people are saying, “Oh, that sounds crazy,” or “you used that off-label.” I think we all know that we are all rationally taking off-label drugs all the time. We explain the benefits and the risks to patients.

Matt Hoffman: Absolute. Thank you so much for being with me today.

Transcription edited for clarity.

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