Multiple Sclerosis in the Time of Coronavirus

I’m receiving daily calls from my MS patients who are understandably worried that their disease-modifying-therapy raises their risk of being infected with, and dying from, Covid-19.

In my opinion and that of most MS specialists, they should continue their medication, especially the highly effective drugs, such as Tysabri, Ocrevus, and Mavenclad. They were started on these medications because they have highly active MS and are at risk of relapses and worsening disability off medication.

Here’s the breakdown:

1. Tysabri blocks the blood-brain barrier and does not affect the immune system at all.
2. Ocrevus targets B-cells only. T-cells are much more important in fighting viruses and are spared.
3. Mavenclad targets B-cells more strongly than T-cells.
4. Gilenya and Tecfidera/Vumerity have not been associated with viral infections other than herpes zoster. Patients may wish to take Valtrex 1000mg daily even though it has no proven activity against Covid-19.
5. Aubagio and interferons are safe and, in fact, have anti-viral properties. They may not be protective against Covid-19 but certainly do not increase the risk.
6. Copaxone seems safe.
7. Lemtrada in an induction and not a maintenance therapy.

The virus seems to provoke an auto-immune response in the lungs which may be more damaging than the infection itself and may explain why older patients do worse. In fact, a new clinical trial will test Actemra, a potent monoclonal antibody effective against rheumatoid arthritis and NMO, an auto-immune disease that can mimic MS.

Lastly, there are anecdotal reports of MS patients on various DMT’s who contracted Covid-19 and did well.