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When to get Shingrix vaccine when taking Ocrevus

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    When to get Shingrix vaccine when taking Ocrevus

    I am almost 70 and have too many friends who've suffered from shingles.

    I've been taking DMDs since 2000, can walk shorter distances using forearm crutches, often use a scooter.

    I had my first Ocrevus infusion in early October and am doing well. The second full infusion will be in early April.

    Now that Shingrix is available I asked my neurologist to find out at what point in the Ocrevus cycle I should get it.

    She didn't know, tells me she'll ask the rep, but I'd appreciate hearing from other MS'ers who've looked into this.

    I'm either RRMS or SPMS - hard to tell due to 18 years of DMDs.

    #2
    I have had 3 bouts of shingles and they suck. They finally put me on a 3-month stint on valacyclovir and then gave me the Zostavax shingles vaccine.

    Considering Shingrix is a "dead" vaccine the chances of having a reaction are negligible. I would be more concerned about taking a brand new vaccine than having increased MS activity from Shingrix.

    Here's a blurb from the MS Society on the "live" virus.

    Shingles vaccine (Zostavax®)
    • Zostavax, is a live-virus vaccine to prevent shingles. MS neurologists do not recommend live-virus vaccines for people with MS because these vaccines can lead to an increase in disease activity. However, Zostavax is an exception because most people have had chicken pox earlier in their lives and therefore already have the virus in their bodies. Each person needs to discuss the potential benefits and risks of this vaccine with her or his healthcare provider.


    https://www.nationalmssociety.org/Li...s/Vaccinations

    Comment


      #3
      NMSS on Shingrix

      Originally posted by Marco View Post
      I have had 3 bouts of shingles and they suck. They finally put me on a 3-month stint on valacyclovir and then gave me the Zostavax shingles vaccine.

      Considering Shingrix is a "dead" vaccine the chances of having a reaction are negligible. I would be more concerned about taking a brand new vaccine than having increased MS activity from Shingrix.

      Here's a blurb from the MS Society on the "live" virus.

      Shingles vaccine (Zostavax®)
      • Zostavax, is a live-virus vaccine to prevent shingles. MS neurologists do not recommend live-virus vaccines for people with MS because these vaccines can lead to an increase in disease activity. However, Zostavax is an exception because most people have had chicken pox earlier in their lives and therefore already have the virus in their bodies. Each person needs to discuss the potential benefits and risks of this vaccine with her or his healthcare provider.


      https://www.nationalmssociety.org/Li...s/Vaccinations
      Ouch! Three episodes of shingles!

      Thanks for the link - I just visited the NMSS page and it hasn't been updated re Shingrix.

      If I get a response from my neuro I'll try to update this page.

      Comment


        #4
        Shingrix notes from NMSS

        A few months back I asked my neuro about Shingrix. She didn't get an answer but here is what the NMSS says.
        The CDC recommends Shingrix, a non-live vaccine for the prevention of herpes zoster (shingles) and related complications. The vaccine, which is given in two doses separated by 2 to 6 months, is recommended over Zostavax® (the previously approved vaccine for shingles). Shingrix is approved for adults 50 years and older:
        whether or not they have had a prior episode of herpes zoster or have had a dose of Zostavax
        who have a chronic medical condition, unless there is a specific reason why the individual should not have it
        who are getting other adult vaccines such as influenza and pneumococcal (pneumonia) vaccines
        No studies of Shingrix have been done in people with MS. However, in two clinical studies with Shingrix, there was no increase in immune-mediated conditions.
        The CDC indicates that a person who is taking a low-dose immunosuppressive therapy or is going to begin taking an immunosuppressive medication can take Shingrix. It is very important to discuss this vaccine with the healthcare provider who is treating your MS to ensure that it is appropriate for you.

        My next Ocrevus infusion is in October - I will try to get this shot in early July.

        Comment


          #5
          I am on Tysabri, but I have had my first dose of Shringrix and am looking to have my 2nd this week. I am on a 6 week infusion schedule, so I had my first dose at the mid-point, i.e. 3 weeks. I found it just like any other shot and had no reaction at all. Well, my left arm was sore for 48 hours, so if you sleep on your side, have it in the opposite arm. However, I wonder if I didn't "tighten up", and that made it worse. I wouldn't be concerned at all. Medicare doesn't pay, so it is $160 and change for each shot. When I called our local clinic, they said the shots are are only given at one of the large drug store chains, i.e. CVS. Also, it is so popular, there seems to be a supply issue, so I'd definitely call first. Good luck!

          Comment


            #6
            I had shingles last summer so I'd like to get the vaccine. Any idea why Medicare doesn't pay for it?

            Comment


              #7
              No idea...best guess...too expensive.

              Comment


                #8
                Ocrevus and Shingrix

                Originally posted by GardeningMSer View Post
                I am almost 70 and have too many friends who've suffered from shingles.

                I've been taking DMDs since 2000, can walk shorter distances using forearm crutches, often use a scooter.

                I had my first Ocrevus infusion in early October and am doing well. The second full infusion will be in early April.

                Now that Shingrix is available I asked my neurologist to find out at what point in the Ocrevus cycle I should get it.

                She didn't know, tells me she'll ask the rep, but I'd appreciate hearing from other MS'ers who've looked into this.

                I'm either RRMS or SPMS - hard to tell due to 18 years of DMDs.
                Does anybody know if/when Shingrix can be taken IF taking Ocrevus?

                Comment


                  #9
                  Originally posted by whtrsh View Post
                  Does anybody know if/when Shingrix can be taken IF taking Ocrevus?
                  Shringrix is a killed virus, so I don’t know why you couldn’t take it. It is no different than a flu shot. I’m on Tysabri, so I took both doses midway betweenmy infusions. Definitely check with your doc, first.

                  Comment


                    #10
                    Compensation

                    Originally posted by Leenyi View Post
                    I had shingles last summer so I'd like to get the vaccine. Any idea why Medicare doesn't pay for it?
                    I have not yet gotten Shingrix mostly because the pharmacies are still out of it. My understanding is that and most of it will be paid for on Medicare especially if you already are through the “donut hole.” Someone told me the other day that certain pharmacies did not charge at all and others charge a minimal amount depending on the Medicare schedule you’re at and what kind of Medicare policy you have. I guess I’ll find out soon. I take Copaxone so I doubt if it’s going to be a problem as far as that goes.

                    Comment


                      #11
                      Originally posted by itasara View Post
                      I have not yet gotten Shingrix mostly because the pharmacies are still out of it. My understanding is that and most of it will be paid for on Medicare especially if you already are through the “donut hole.” Someone told me the other day that certain pharmacies did not charge at all and others charge a minimal amount depending on the Medicare schedule you’re at and what kind of Medicare policy you have. I guess I’ll find out soon. I take Copaxone so I doubt if it’s going to be a problem as far as that goes.
                      I'm on Medicare (65+ kind), with Part D, and I paid $160 for each shot. They did run my Part D card, and the $160 is what was left as my responsibility.

                      Comment


                        #12
                        Shingrix - response to first shot

                        Originally posted by GardeningMSer View Post
                        I am almost 70 and have too many friends who've suffered from shingles.

                        I've been taking DMDs since 2000, can walk shorter distances using forearm crutches, often use a scooter.

                        I had my first Ocrevus infusion in early October and am doing well. The second full infusion will be in early April.

                        Now that Shingrix is available I asked my neurologist to find out at what point in the Ocrevus cycle I should get it.

                        She didn't know, tells me she'll ask the rep, but I'd appreciate hearing from other MS'ers who've looked into this.

                        I'm either RRMS or SPMS - hard to tell due to 18 years of DMDs.
                        I had my first #Shingrix shot about a month ago and definitely had a reaction. MS flared causing noticeable weakness which slowly improved. I am not sure I'll get the second shot, my very bright wife thinks skipping it would be the best course.

                        PS - neuro called today and told me that if I had any vaccinations in the last two weeks she would delay Thursday's Ocrevus infusion.

                        Comment


                          #13
                          I've had 3 bouts of shingles so I am interested in getting Shingrix, but was waiting additional time for more post-marketing data. I've been stable on Rituximab and don't want to upset the proverbial apple cart.

                          I'm sorry that you had a negative reaction to the vaccine and hope you were the extremely rare exception.

                          Thank you for sharing your story and I wish you well.

                          Comment


                            #14
                            vaccination guidelines in PubMed

                            I'm wondering how long a period you had between your previous relapse and this one after the Shingrix?

                            I've been relapse-free since starting fingolimod/Gilenya in 2006 during its clinical trial. My walking has deteriorated though and my neuro suggested starting Rituxan (early version of Ocrevus). I've had three doses so far. I also had shingles (first and only time) during the fingolimod clinical trial. I don't want to get shingles again, but I certainly don't want to have an MS relapse either.

                            After a lot of looking, I found this article that on pubmed that was published in Jan 2019: Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies. It seemed to be the most researched advice I've found.

                            Among their recommendations was:
                            "Statement 2c: In patients with immune-mediated diseases treated with rituximab who require optimal vaccine immunogenicity, we recommend that immunization be deferred to ⩾5 months after the last dose and at least 4 weeks prior to the subsequent dose of rituximab.
                            Strong recommendation; low-level evidence."

                            To read the entire study google "pubmed PMC6330697".

                            I'm due for my fourth Rituximab dose in mid-August, so I guess I could get a dose now and another in January 2020. You have me a little worried, though. I don't want to get shingles again, but I certainly don't want to have an MS relapse either.

                            Comment

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