It was said teriflunomide is imunomodulatory and not immunosuppressive and I said it is supposed to inhibit DNA synthesis and so it maybe immunosuppressive to a proliferating immune response and so what happens to vaccinations?
It seems (90%) most people can make one. So that is good news for people on teri, if they get to make a COVID vaccine.
Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis. Bar-Or A, Freedman MS, Kremenchutzky M, Menguy-Vacheron F, Bauer D, Jodl S, Truffinet P, Benamor M, Chambers S, O’Connor PW. Neurology. 2013; 81:552-8.
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 patients with relapsing forms of multiple sclerosis (RMS) 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 patients with influenza strain-specific antibody titers ≥40, 28 days postvaccination.
RESULTS: More than 90% of patients achieved post-vaccination antibody titers ≥40 for H1N1 and B in all groups. For H3N2, titers ≥40 were achieved in ≥90% of patients in the 7 mg and IFN-β-1 groups, and in 77% of the 14-mg group, respectively. A high proportion of patients 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 patients with a prevaccination titer <40 achieving seroprotection was ≥61% across the 3 treatment groups and 3 influenza strains. However, fewer patients 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 patients generally mounted effective immune responses to seasonal influenza vaccination, consistent with preservation of protective immune responses.
Immune response to neoantigen and recall antigens in healthy subjects receiving teriflunomideECTRIMS Online Library. Bar-Or A. 10/03/13; 34102; P622 . This showed response to a Rabies vaccine. The response was blunted by still present.
To put this in perspective, lets have a quick look at
Stokmaier D, Winthrop K, Chognot C, et al. Efficacy of ocrelizumab on vaccine responses in pateinets with multiple sclerosis (S36.002). Neurology; 90 (15 Suppl): S36.002
Seroprotective titers at 4 weeks against five influenza strains (season 2015/2016 and 2016/2017) ranged from 55.6% to 80.0% in OCRelizumab group and 75.0% to 97.0% in Interferon Beta group
Participants received dual infusion of OCR 300 milligrams (mg) on Day 1 and then on Day 15, and then participants will further receive immunization course at 12 weeks post-OCR treatment until Week 24.
The influenza vaccine was given as an intramuscular injection any time between Day 85 and Day 144 (about 3-5months). The results were assessed 4 weeks later
|Strain 1 = H1N1CA09||Ocrelizumab|
| Beta Interferon|
|Strain 2 = BPHU13||33 participants||31 participants|
|Strain 3 = H3N2SW13||30 participants||27 participants|
The titre (level).
|Pre-Vacination Strain 1||126.5(78.2 to 204.4)||86.0(55.4 to 133.6)|
|4 weeks||154.8(103.8 to 230.8)||390.8(264.0 to 578.4)|
|Pre-Vaccination Strain 2||67.7(49.5 to 92.4)||54.0(34.6 to 84.3)|
|4 week||84.6(64.3 to 111.3)||43.1(156.3 to 377.9)|
|Pre-Vaccination Strain 3||110.0(72.9 to 166.0)||62.6(41.2 to 95.2)|
|4 weeks||134.5(94.9 to 190.5)||342.8(219.1 to 536.3)|
Although the frequency of people making the antibody response is reduced as is the level of antibody (titre). However, it shows that people can still make an antibody response to new antigens and by inferrence new infections.
Is that good enough? I don’t know.