Teriflunomide and flu vaccination

What can I do to prevent relapses? #MSBlog #MSResearch

I am on Teriflunomide; is it safe to have the flu vaccine? #MSBlog #MSResearch

“The following question is  common one. What can I do to reduce the chances of having a relapse? Outside of taking a DMTs and falling pregnant the evidence is poor. It is also not appropriate to treat MS with pregnancy. The latter does little to help men.”
“Well can we reduce relapses? Yes, I suspect so. Relapse rates drop with age and disease duration; natural history studies in MS are consistent on this.”
“Stress and infections have been linked to triggering relapses; so I always recommend trying to reduce your stress levels and avoiding infections.”
“How do you reduce stress? This essentially part of the holistic lifestyle approach to treating MS and includes improving your diet, sleep and exercise regime and managing anxiety and depression.”

“Another lifestyle factor is vitamin D. Vitamin D deficiency is closely linked to MS disease susceptibility and may play a role in suppressing relapses. The data to date on the latter is weak and inconclusive and we need the larger and better designed trials to report on this. However, there are other, more compelling, reasons why MSers should maintain their vitamin D levels above normal, in particular to look after your bones.”

“Infections are more difficult to avoid. One way is to have the seasonal flu vaccine. Therefore it is reassuring to see the study below demonstrating that if you are on the new oral therapy teriflunomide that you can still mount an immune, or antibody, response to the vaccine. This tells us two things; (1) teriflunomide is not a potent immunosuppressive agent and (2) teriflunomide is unlikely to suppress immune responses to recall antigens, or infections we have previously been exposed to. The latter is important and allows us to reassure MSers about the safety profile of teriflunomide. In fact, when you look at the safety data on teriflunomide from the clinical development programme infections, in particular opportunistic infections, were not a problem.”

“Is flu vaccination safe in MS? Yes, there have been numerous studies demonstrating the safety of seasonal flu vaccination in MSers. The vaccine does not trigger MS disease activity in the form of relapses or new lesions on MRI. Hence I recommend it to all my MSers on an annual basis.”

“If you have MS you should have the seasonal flu vaccine; it is one of the boxes you need to tick on your holistic train journey called managing my MS.”

Epub: Bar-Or et ak. Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis. Neurology. 2013 Jul 12. [Epub ahead of print]

OBJECTIVE: To investigate the effect of teriflunomide on the efficacy and safety of seasonal influenza vaccine.

METHODS: The 2011/2012 seasonal influenza vaccine (containing H1N1, H3N2, and B strains) was administered to RRMSers treated for ≥6 months with teriflunomide 7 mg (n = 41) or 14 mg (n = 41), or interferon-β-1 (IFN-β-1; n = 46). The primary endpoint was the proportion of MSers with influenza strain-specific antibody titers ≥40, 28 days postvaccination.

RESULTS: More than 90% of MSers achieved postvaccination antibody titers ≥40 for H1N1 and B in all groups. For H3N2, titers ≥40 were achieved in ≥90% of MSers in the 7 mg and IFN-β-1 groups, and in 77% of the 14-mg group, respectively. A high proportion of MSers already had detectable antibodies for each influenza strain at baseline. Geometric mean titer ratios (post/prevaccination) were ≥2.5 for all groups and strains, except for H1N1 in the 14-mg group (2.3). The proportion of MSers with a prevaccination titer <40 achieving seroprotection was ≥61% across the 3 treatment groups and 3 influenza strains. However, fewer MSers in the 14-mg than the 7-mg or IFN-β-1 groups exhibited seroprotection to H3N2 (61% vs 78% and 82%, respectively).

CONCLUSION: Teriflunomide-treated MSers generally mounted effective immune responses to seasonal influenza vaccination, consistent with preservation of protective immune responses.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that teriflunomide generally does not adversely impact the ability of MSers with RMS to mount immune responses to influenza vaccination.

CoI: multiple

Other posts of interest on flu vaccines

Research: Seasonal/Flu vaccines in MS-Safety – Multiple Sclerosis …
10 Nov 2011
RESULTS: Five of the 49 vaccinated patients reported side effects of fever or flu-like symptoms associated with the administration of either of the vaccines: there were no complications or need for hospitalization. No patient …

Multiple Sclerosis Research: H1N1 flu vaccine is safe in MS’ers
12 Aug 2011
H1N1 flu vaccine is safe in MS’ers. Epub ahead of print: Farez et al. H1N1 vaccination does not increase risk of relapse in multiple sclerosis: a self-controlled case-series study. Mult Scler. 2011 Aug 9. A small study showing …

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Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

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