Treatment in the COVID era – Distancing and DMTs
“Physical distancing” has become the byword of the pandemic with public health officials recommending that everyone maintain a two-metre perimeter to limit the spread of the virus. Such precautions are especially relevant to people with multiple sclerosis. While it does not appear that MS makes a person more susceptible to the CoV-2 virus, there has been a suggestion (not verified) that COVID-19 may worsen MS (Di Stadio and colleagues. Mult Scler Relat Disord 2020;46:102540), much like other viral illnesses can cause an MS flare-up.
Perhaps the greater concern is the risk of COVID in people with MS who are more vulnerable, such as those with significant disability and/or other conditions (heart or lung disease, kidney disease, diabetes, obesity).
The practice of physical distancing among people with MS was recently addressed by European researchers in the RADAR study, which used data from cell phones and Fitbit devices to track movement and activity (Sun and colleagues. J Med Internet Res 2020;22:e19992). They found that during lockdown, people stayed at home for more hours in the day (up to 4 hours more), did not go very far (less than 1 km), walked less (up to 3000 fewer steps per day), and had less contact with other people. (Google also tracks people’s mobility, see https://www.google.com/covid19/mobility/). People with MS also went to bed later and slept more.
When it comes to treating your MS, efforts at physical distancing can be a challenge for three main reasons. The first is that for some medications – Tysabri, Ocrevus and Lemtrada – you will need go to a healthcare facility for several hours to get your treatment. The first dose of Gilenya must also be administered at a clinic, which requires a 6-hour stay. It should be noted that infusion centres have taken added steps to sanitize the workspace and reduce the number of people at one time in the waiting room. But you will need to phone ahead to find out what the centre’s procedures are. Getting to the infusion centre may be difficult if you want to avoid public transportation or need to get a ride from someone outside your immediate circle.
A second consideration is the need to go to a healthcare facility for blood tests and other procedures. For people currently taking a medication, these requirements will vary widely depending on the treatment you are taking (your doctor will determine how often you need to go for tests). With injectable drugs (Copaxone, the interferons) you generally need to get a blood test every six months or so. With Tecfidera you need a blood test once a year. For Aubagio, you need monthly blood tests for the first six months, then periodic blood tests thereafter; you should also routinely check your blood pressure (at home or at the pharmacy). Mavenclad requires a blood test before each course of treatment. Gilenya requires blood tests every three months and periodically thereafter; you will also need to visit an eye doctor for an examination and measure your blood pressure periodically.
People on Tysabri should have their blood checked every six months. The most difficult is Lemtrada, which requires monthly blood tests during the two years of treatment and for four years afterward.
The third consideration when trying to maintain distancing is the need to visit an MS clinic. Many clinic visits are now done remotely – either by phone or videoconferencing. This is a necessary stopgap – and often welcomed by people because it saves on travel time, parking expenses, etc. – but is not ideal because it does not allow for a proper examination. Some clinics are seeing fewer people and limiting visits to people who appear to be running into trouble, such as those with relapses, worsening symptoms or increasing disability. So there are added benefits to taking an effective medication that will get your symptoms under control and prevent relapses: you can remain at home, do your clinic checks over the phone and maintain your distance from the COVID crowds.
In Part 3 we’ll look at MS treatments and the COVID vaccine.
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