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Is It Time to Consider the Live Attenuated Varicella-Zoster Virus (Vzv) Vaccination Safe in Patients With Multiple Sclerosis Treated With Natalizumab? an Extension Study of the First Iranian Experience Publisher Pubmed



Paybast S1 ; Nahayati MA2 ; Mohammadi SS3 ; Navardi S3 ; Poursadeghfard M4 ; Aboutorabi M5 ; Heydari H3 ; Sahraian MA3
Authors
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Authors Affiliations
  1. 1. Department of Neurology, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  3. 3. Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  5. 5. Department of Neurology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Source: Multiple Sclerosis and Related Disorders Published:2025


Abstract

Introduction: Vaccination with live attenuated vaccines is generally not recommended in patients with MS (PwMS) treated with natalizumab. However, there are new insights to reconsider vaccination practice in PwMS. The present study aimed to report the results of live-attenuated varicella-zoster virus (VZV) vaccination in PwMS while receiving natalizumab. Material and methods: A multi-center retrospective cohort study was accomplished on VZV seronegative patients with MS who were vaccinated with the live-attenuated VZV vaccine while being treated with natalizumab. Results: A total of 89 MS patients participated in this study, of which 71.9 % were female and had a mean age of 27.76 ± 8.12 years. All patients had highly active MS with a mean disease duration of 3.20 ± 3.59 years. 52.8 % of the patients were treatment naive with a mean expanded disability status scale (EDSS) of 1.87 ± 1.08. All patients received two doses of the live-attenuated VZV vaccine with an interval of at least one month. None of the patients developed serious adverse events. In addition, over a mean follow-up of 1.63 ± 0.43 years, no evidence of disease activity or progression was observed. Conclusion: Our preliminary findings suggest the safety of live-attenuated VZV vaccine in highly selective PwMS treated with natalizumab highlighting an individualized approach in particular circumstances. © 2025