Guidelines for DMT Use as COVID-19 Spreads

People with multiple sclerosis have unique concerns about the new coronavirus and the COVID-19 disease that it causes. Many of us use disease-modifying therapies (DMTs) that suppress our immune systems and give us an extra element to worry about when we plan our defense against this virus.

To help us make wise decisions, the U.K.’s MS Trust and the Italian Society of Neurology have created COVID-19 guidelines related to DMTs, and both organizations’ recommendations are similar. They balance concerns of abruptly ending any MS treatment with those of possibly being more susceptible to this illness because some DMTs suppress the immune system.

Italian guidelines

According to BartsMS Blog, the Italian neurologists wrote that “Given the lack of knowledge or data on the COVID-19 disease course in MS patients receiving DMTs, at present there is no recommendation to stop the different DMTs and therefore expose MS patients to the risk of MS exacerbations. We, therefore, recommend continuing the current DMT specifically with [the following possible modifications]”:

DMTs that can be prescribed and used as usual:

• Beta interferons, including Avonex, Betaseron, Extavia, Plegridy, and Rebif
• Copaxone (glatiramer acetate)
• Aubagio (teriflunomide)
• Tecfidera (dimethyl fumarate)
• Gilenya (fingolimod)
• Tysabri (natalizumab)

DMTs whose start or continuation might be delayed, based upon individual circumstances:

• Ocrevus (ocrelizumab)
• Lemtrada (alemtuzumab)
• Rituxan (rituximab)
• Mavenclad (cladribine)

A full translation of the Italian guidance by neurology professor Gavin Giovannoni can be found here.

UK guidelines

The MS Trust adds to its guidance Mayzent (siponimod) and Arzerra (ofatumumab), which are available by private prescription in the U.K. According to the Trust, using these DMTs “could also affect your risk regarding COVID-19 and should be discussed with your neurologist or healthcare professional.”

It also cautions that Gilenya (fingolimod) “may increase your chances of having more severe viral and other infections, including COVID-19. However, if you are already taking fingolimod, stopping can lead to rebound MS disease activity, which in many cases would outweigh the risks of the virus. If you are considering beginning a course of fingolimod in the near future, you and your neurologist could consider an alternative DMT for the time being.”

Finally, it adds that “Haematopoietic stem cell transplantation (HSCT) is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells. This treatment greatly hampers your immune system for a period of time and you and your neurologist or healthcare professional should consider delaying this treatment.”

Other national guidelines

The National MS Society in the U.S. is much less specific about DMTs, saying only: “People with MS should continue disease-modifying therapies (DMTs) and discuss specific risks with their MS healthcare provider prior to stopping a DMT.” Neither MS Australia nor the European Multiple Sclerosis Platform offers any DMT-specific guidance.

To cruise or not to cruise

My wife and I were planning to join our son and his family on a short cruise at the end of April. Two days ago we were still considering making this trip. Even though I’m 71 and have been treated with Lemtrada, I thought that with proper precautions the risks would be minimal.

However, Dr. Anthony Fauci, the top infectious disease expert in the U.S., says that elderly people shouldn’t take a cruise. Period. Dr. Fauci is a man whom I reported on for many years when I worked as a journalist — I highly respect his judgment and knowledge.

Additionally, the U.S. Centers for Disease Control and Prevention has issued guidance recommending that “travelers, particularly those with underlying health issues, defer all cruise ship travel worldwide.” The U.S. State Department has issued the same message. Former Food and Drug Administration head Scott Gottlieb says that “Everyone over 60 should become a hermit for a month.”

Since then, things have become even more serious.

So, no cruise with the grandkids this year. We’re postponing it until 2021. Let’s all hope we’re out of the coronavirus woods by then. Let’s hope that a vaccine for this coronavirus has been developed. Let’s also hope that people who think that vaccines harm, rather than help, will see the light and get themselves and their children vaccinated for influenza, measles, and other diseases for which prevention is available. Let’s do what we can to hold the line on all infectious diseases.

You’re invited to visit my personal blog at www.themswire.com.

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.