Important to keep treating MS during COVID-19 epidemic
People with MS do not have a higher risk of being infected and COVID-19 will not be more severe in most cases, according to the Canadian Network of MS Clinics (https://mssociety.ca/library/document/4u3HWTSZcVqnFeIL8pwgkOfxE6vaDKPG/original.pdf). So people with MS should continue to take their disease-modifying therapy (DMT) to control their MS.
There are now over 300,000 cases of COVID-19 worldwide (over 2,000 in Canada as of March 24 with a 1.1% mortality rate). To protect yourself and your family against infection, Health Canada advises people to be on the alert for symptoms and isolate yourself if you have symptoms (see links to infographics below).
The risks of COVID-19 infection are similar to those seen in the non-MS population. At higher risk are people who are older, have other medical conditions (such as diabetes, heart disease or chronic respiratory conditions), or limited mobility (since this may increase the risk of respiratory infections). Like other viral infections, COVID-19 can worsen your MS symptoms, but it’s important to know that this short-term worsening is not a true relapse – your symptoms should get better over the next week or so as the infection clears.
With respect to MS medications, there are three key considerations:
1. Will the DMT suppress my immune response and/or increase my risk of infection?
There are three broad categories of MS drugs. The first group has minimal or no immune-suppressing effects. This includes the injectable drugs Copaxone and the interferons (Avonex, Rebif, Betaseron/Extavia and Plegridy), the oral drugs Aubagio and Tecfidera, as well as Tysabri. For example, in clinical trials of Aubagio and Tecfidera (the most commonly used DMTs), treatment was not associated with a higher risk of infections, including viral infections (O’Connor and colleagues. N Engl J Med 2011;365:1293-1303. Gold and colleagues. N Engl J Med 2012;367:1098-1107). So there is no need to stop treatment with these medications – even if you develop COVID-19.
The second category is immune-suppressing drugs, which includes Gilenya and Mavenclad. There is no need to stop Gilenya; if you develop COVID-19, it’s important to contact your healthcare provider to discuss your options (see below). If you’ve taken Mavenclad in the past few months, you will need to take extra precautions against infection. If you’re scheduled for the next treatment course, talk to your neurologist beforehand – it may be advisable to delay the next course of Mavenclad (you can delay for up to 6 months and still maintain control of your MS).
The third category of DMTs is drugs that reduce the number of immune cells in your body and includes Ocrevus and Lemtrada (Mavenclad also fits in this category). These drugs have long-lasting effects on the immune system so they can’t be “stopped”. Your doctor and you will need to discuss if it’s best to start one of these treatments now. That decision will depend on the severity of your MS and other factors specific to your situation. If you’re already taking one of these drugs, you can delay the next course of treatment for several months. Take extra precautions against infection if you’re currently taking Lemtrada.
2. Will treatment mean that I have to leave my house? Some DMTs (Tysabri, Ocrevus, Lemtrada) must be administered at a clinic so you’ll need to be especially rigorous in avoiding infections. Try to maintain a safe distance from others (at the clinic, on public transport), wash your hands frequently and use hand sanitizer. The weather is still cold so wear your gloves wherever you go (but avoid touching your face). The same applies if you have to visit a clinic or doctor’s office for the periodic blood tests or other health procedures (e.g. eye exams) that are required for some DMTs.
3. Is it safer to stop my DMT? No. Your medication is needed to control your MS so it’s important to stay the course. Indeed, your MS may worsen if you abruptly stop some treatments (e.g. Gilenya or Tysabri). Talk to your MS clinic if you have concerns about your treatment. Your clinic doctor or nurse know your specifics and can provide you with personal advice on how best to protect yourself.
Many MS clinics and neurologists are now limiting office visits to urgent cases only (although “urgent” isn’t always well-defined). If you have concerns about your MS or the medications you’re taking, call or email your healthcare provider. Many issues can be addressed by telephone or via videoconferencing so you won’t need to visit the clinic. Check with your clinic beforehand because procedures may change as the COVID-19 situation evolves.
Click to download Health Canada’s infographic on self-monitoring and isolation.
Share this article
Facebook Twitter pin it! Email