The Covid-19 pandemic presents a challenge for physicians managing patients with multiple sclerosis (MS), as these patients have additional reasons for concern, says GlobalData, a leading data and analytics company.
According to new guidelines for treating MS during the pandemic that has been published by national professional bodies, such as the Italian Society of Neurology and Association of British Neurologists, and patient organisations, such as the National MS Society, MS International Federation, UK MS Society, and MS Australia, most MS patients will benefit more from continuing their MS treatments than stopping due to concerns over Covid-19.
However, the central treatment for MS is immunosuppressive therapies, and their use should be stopped or delayed as long as possible, as it may add more risks to develop severe Covid-19 symptoms especially in patients with comorbidities who are elderly. The effects of these therapies alter the proliferation, function, and number of lymphocytes, thus increasing the risk of patients contracting viral and respiratory infections.
Therapies that have a high level of immune suppression should be avoided during the pandemic. These include Sanofi’s Lemtrada (alemtuzumab), Merck’s Mavenclad (cladribine), Novartis’ Gilenya (fingolimod HCL), Biogen’s Tecfidera (dimethyl fumarate), and other sphingosine 1-phosphatemodulators such as Celgene’s Zeposia (ozanimod HCL) and Novartis’ Mayzent (siponimod fumarate). Instead, patients should be placed on other therapies that have immunomodulatory effects but no risk of systemic infections, such as Teva’s Copaxone (glatiramer acetate).
Anti-CD20 therapies, including Roche’s Ocrevus (ocrelizumab) and the use off-label of rituximab, are typically dosed regularly every six months, so physicians will have to re-evaluate the dosing if patients are defected by B-cell and antibody depletion.
Some MS immunotherapies may increase the risk of patients experiencing more severe Covid-19 infections, and physicians must evaluate the risks associated with each patient when administering these drugs. However, in most MS patients, the benefits of continuing treatment will prevail over the risks of halting treatment with MS therapy.