Stratford woman 'in a really difficult spot' must choose between MS medication or 2nd COVID-19 vaccination

A Stratford woman says Ontario's recommended COVID-19 vaccination schedule has forced her to make a difficult decision: Whether to get her second shot or stay on track with treatment to prevent her multiple sclerosis from worsening. 

Lindsey Martchenko, 32, was diagnosed in 2018 with MS, a chronic autoimmune disease that affects the central nervous system, and can cause symptoms including extreme fatigue, weakness and loss of muscle co-ordination.

Since then, she's been receiving an infusion of the medication ocrelizumab, sold under the brand name Ocrevus, every six months. The immunosuppressive drug, recommended for people with relapsing forms of MS, works by controlling symptoms and stopping certain cells from causing damage. 

"My body has loved Ocrevus. I haven't had any new flare-ups of MS," said Martchenko, a mom who works full time as a fundraising specialist and volunteers with the MS Society of Canada's Oxford-Perth chapter.

I don't want to end up being in a position where I'm not protected against COVID or I haven't done everything possible to keep myself healthy.- Lindsey Martchenko of Stratford, Ont.

But the drug can also make MS patients more vulnerable to serious COVID-19 complications that could put them on a breathing tube, so it's important they get fully vaccinated as soon as possible, said Dr. Courtney Casserly, a neurologist based out of the London Health Sciences Centre.

Ocrevus is also believed to make the COVID-19 vaccine less effective if given too soon after the last infusion of the MS drug, said Casserly. It's recommended people on Ocrevus wait at least four months after their last dose before getting vaccinated, she said, although even longer would be better.

Narrow window of time

That means patients like Martchenko have a narrow window to get both vaccinations against COVID-19, to ensure they are fully effective and stay on track with their MS treatments.

They should be getting vaccinated three to four weeks apart — as per the original instructions for Pfizer and Moderna — to allow enough buffer time on either side of the infusions. This schedule would also allow them to keep getting their infusions on schedule, said Casserly. 

But the current four-month recommended interval between doses makes that impossible, said Casserly. 

They either must delay an Ocrevus infusion or hold off on vaccination — neither of which, she said, is ideal.

"This particular patient population ... they're making this difficult decision of whether or not they want to be protected against COVID or whether or not they want to go forward with a treatment that could be preventing worsening of their MS," said Casserly.

"It puts them in a really difficult spot." 

Difficult choice

Martchenko, who received her first vaccination at the end of March, was scheduled for an Ocrevus infusion the week of May 10, but has decided to postpone it so she can stay on track with her COVID-19 vaccinations. 

If she had proceeded with her scheduled Ocrevus infusion, Martchenko said, she would have had to wait until mid-September to get the second dose of the vaccine. She said that didn't sit right with her.

"As a person on Ocrevus, I am more prone to upper respiratory infections and have been told by a medical professional that if I were to get COVID, I would likely end up in the hospital because of that. 

"I don't want to end up being in a position where I'm not protected against COVID or I haven't done everything possible to keep myself healthy." 

Martchenko said she reached out to both Huron Perth Public Health (HPPH) and the nearby Middlesex-London Health Unit (MLHU) asking if she can get an exemption to receive her second dose, but didn't heard back. 

In a statement to CBC News, HPPH said it couldn't comment on individual health matters for privacy reasons. But the health unit said it follows guidelines on vaccine dose intervals set out by the province in consultation with the National Advisory Committee on Immunization (NACI).

The health unit explained those guidelines only allow certain patients to receive their vaccines on a four-week interval, such as transplant patients and people receiving chemotherapy. MS patients taking Ocrevus are not among those eligible for this kind of schedule.

The MLHU said it is also following provincial guidance, and directed questions involving Stratford to the HPPH. 

Shortened interval

On Monday, Health Minister Christine Elliott said the province is expecting increased shipments of COVID-19 vaccines in the weeks to come, which may allow it to shorten the current four-month interval between the first and second shots.

As that supply ramps up, Casserly hopes patients taking Ocrevus, and a similar drug called rituximab, will be prioritized to get that second dose sooner. She said while it isn't clear just how many people are taking these drugs, it's a relatively small proportion of the population who would get a lot of benefit from an expedited schedule. 

CBC News asked the Ministry of Health if it plans to allow these patients to get vaccinated on the four-week schedule or to prioritize the group for the single-dose Johnson and Johnson vaccine when it becomes available. 

The ministry did not provide a statement by publication time.