Updating the Shifting MS-COVID-19 Treatment Equation
It’s been a few weeks since I’ve written about the impact that COVID-19 is having on people with MS. Since then, the picture has changed — not a lot, but enough for the MS International Federation to modify its recommendations for that illness, people with MS, and disease-modifying therapies (DMTs).
The treatment equation for COVID-19 and MS is complex because of the dynamic nature of the way this virus attacks the body. In some people, it appears to trigger a cytokine storm, where small proteins in the immune system overreact to an infection, and in addition to attacking the virus, attack and severely damage the lungs and other vital organs.
That kind of attack seems similar to the way an overactive immune system attacks the central nervous system in people with MS. So, would our hyperactive immune system offer a level of protection against COVID-19, or would it make things worse? Do our DMTs, some of which suppress our immune system, offer any protection, or do they make things worse?
The MSIF guidance
The federation stated that, in general, people with MS who are being treated with a DMT should remain on it. People who are being treated with a DMT who have COVID-19 symptoms should discuss therapy options with their neurologist.
According to the federation, Avonex, Rebif, Plegridy (interferon beta-1a); Betaferon and Extavia (interferon beta-1b); and Glatopa (glatiramer acetate) are unlikely to increase the severity of COVID-19. Some preliminary evidence suggests these DMTs may actually reduce the need for hospitalization after being infected with the virus.
Some evidence suggests that Tecfidera (dimethyl fumarate), Aubagio (teriflunomide), Gilenya (fingolimod), and Mayzent (siponimod) do not increase the risk of COVID-19 symptoms becoming more severe than they otherwise would.
On the other hand, the guidance cautions that therapies targeting CD20 — Ocrevus (ocrelizumab) and Rituxan (rituximab) — may be linked to an increased chance of being admitted to the hospital or requiring intensive care treatment due to COVID-19.
The federation also noted that it doesn’t have enough information about Tysabri (natalizumab), Lemtrada (alemtuzumab), or Mavenclad (cladribine) to judge their safety related to the pandemic.
Risk vs. reward
A decision about whether to start or continue a DMT while COVID-19 continues to be a threat requires balancing the benefits with the potential risks. Do you stop treatment with a DMT that carries with it a severe post-treatment relapse risk, such as Tysabri, to better protect yourself against a possible COVID-19 infection? Do you delay starting an immunosuppressive therapy, such as Ocrevus, when you know that “time = brain,” and delaying treatment could mean MS progression?
The MS-COVID-19 equation keeps shifting, which doesn’t make decisions easier. As a reader of one of my recent columns commented,”First of all, they stopped fingolimod. Then they say that despite causing lymphopenia, there didn’t seem to be a deleterious effect on immune response fighting the illness. So far, so good. Then they go on to say that the immune response suppression caused by a DMT like fingolimod may actually help prevent a cytokine storm.”
It’s a tough decision. I’m not sure what I’d do if my Lemtrada treatments were still in progress. What would you decide?
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.
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Comments
D. Hope.
Where is the research linking increased risk of icu admission for people on anti-CD20 therapies like Ocrevus or Rituxan? I haven’t come across that. Please share your source. Thank you kindly.
Ed Tobias
The information comes from the MSIF recommendations, which say "The advice below was developed by MS neurologists and research experts from MSIF’s member organisations. It is based on expert opinion and preliminary data that is still being analysed, so should be taken with caution. This advice will be reviewed and updated as further evidence about COVID-19 becomes available."
You can read the full recommendations by clicking on the "recommendations" link in my column.
Ed
Judy Crutchfield
Covid seem to be calm in most states until 14 days after we saw many people together on the streets. Could this be the reason for the increase.
Dana
I hate to point fingers, but I will on this. These pharmaceutical companies are making huge profits & their investors also have a $$$stake. Personally, I have taken many of these DMTs over the past 20 years from avonex to tysabri & lemtrada. I’m thankful for them all! However, it would be detrimental to these companies future to let too much negative info out regarding their effects with COVID-19 patients! I agree.. each person Must make a decision for themselves. Just don’t base it all on data, assuming it’s not tainted.
Carolyn Walsh, MSN, RN
I've been wondering what my Ocrevus infusion was going to do to me if I did catch the coronavirus. I had Infusion #1 in January 2020 in 2 parts, and I'm scheduled for the second infusion this July 16th. So the information included in this article was really important to me. Will I end up in ICU on a vent? Will I die? Will the Ocrevus kill me or will it keep me out of a cytokine storm? So many questions but what do you expect? I'm an old ICU/ED nurse.
Rob T.
That's a tough one Mr. Tobias. I've also weighed that option myself regarding Tysabri. I had my 84th infusion last month, and that's been RELAPSE FREE as well. I figured things this way. I am God's child. God made me. God knew I'd get this illness. As to whether or not God........STOP! This is where things get tricky. God also gave us all a "BRAIN", and the freedom of thought to make a choice. I figure if God gave us this tool, work smart not hard. When and if using this tool, our BRAIN, common sense would tell one if you've remained well on it, why stop it? Though, I attribute my own good health to God first, and Tysabri somewhere around 3rd, behind my own dietary regimen. But, would God not think we'll upon me if I had enough faith in him to STOP putting these man-made chemicals into my body? Well, I figure he would. He would be greatly appreciative I think. At the same time however, I think he'd probably be saying something like "YOU IDIOT! I MADE MAN, MAN MADE THIS MEDICINE, SAID MEDICINE IS HELPING YOU, AND YOUR GONNA STOP TAKING IT? WHY'D I EVEN GIVE YOU A BRAIN"?!!! So maybe there's great honor and faith in one strong enough to stop taking or not take any DMT's at all. My faith will remain first and foremost in my description detailing my good health since waking up blind in September 2012. Tysabri is merely HELPING ME, which God knew previously as well. If I'm supposed to stop taking my DMT, I figure something MAJOR will hafta happen, withdrawing it from the realm of it being any real choice of my own. So, while my health has been good and I "THINK" I could probably stop taking my DMT (Tysabri infusions), it's just a THOUGHT. That's it. They come and go. All day everyday. Just like we as humans do, each and every day.