Disease Modifying Therapy Guidance During COVID-19

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If you have multiple sclerosis and you are on a disease modifying therapy (DMT), or are considering going on one, you probably have questions. Many DMTs for MS work by suppressing or modifying the immune system. Some MS medications might increase the likelihood of developing complications from a COVID-19 infection, but this risk needs to be balanced with the risks of stopping or delaying treatment.

For information on vaccines and DMTs, see Timing MS Medications with Vaccines.

We recommend that:

• People with MS currently taking DMTs continue with their treatment, unless advised to stop by their treating clinician.
• People who develop symptoms of COVID-19 or test positive for the infection discuss their MS therapies with their MS care provider or another healthcare professional who is familiar with their care.
• Before starting on any new DMT or changing an existing DMT, people with MS discuss with their healthcare professional which therapy is the best choice for their individual circumstances. The decision should consider the following information:
  • MS disease course and activity
  • The risks and benefits normally associated with different treatment options
  • Additional risks related to COVID-19

We believe DMT decisions should be individualized and made collaboratively between the person with MS and their healthcare provider.

Impact of DMTs on COVID-19 severity

See below for the information we have on the impact of DMTs on COVID-19 severity. Most of this evidence comes from studies before the COVID-19 vaccines were widely available.

• Interferons (Avonex, Betaseron, Extavia, Plegridy, Rebif) and glatiramer acetate (Copaxone) 
  
  These medications are unlikely to impact negatively on COVID-19 severity. There is some evidence that interferons may reduce the need for hospitalization due to COVID-19.


• Dimethyl fumarate (Tecfidera), diroximel fumarate (Vumerity), teriflunomide (Aubagio), fingolimod (Gilenya), natalizumab (Tysabri), ozanimod (Zeposia) and siponimod (Mayzent) 
  
  The evidence available suggests that people with MS taking these medications do not have an increased risk of more severe COVID-19 symptoms.


• Therapies that target CD20 — ocrelizumab (Ocrevus) and rituximab (Rituxan) 
  
  There is some evidence that these may be linked to an increased chance of having a more severe form of COVID-19, including a greater risk for hospitalization. However, these therapies should still be considered as an option for treating MS during the pandemic. People with MS who are taking them or ofatumumab (Kesimpta), which works in the same way, should take precautions to reduce their risk of infection. If people with MS taking these types of DMT test positive for COVID-19, they should contact their healthcare provider as soon as possible to discuss potential treatment options.


• Alemtuzumab (Lemtrada) and cladribine (Mavenclad)
  
  More data on the use of these drugs during the COVID-19 pandemic are required to make any assessment of their safety. People with MS who are currently taking these therapies and are living in a community with a COVID-19 outbreak should discuss their current lymphocyte counts with their healthcare professional. (Lymphocytes are a type of white blood cell that helps protect the body from infection). If their counts are considered low, they should take appropriate precautions to reduce their risk.


• Alemtuzumab, cladribine, ocrelizumab and rituximab 
  
  Recommendations on delaying second or further doses of alemtuzumab, cladribine, ocrelizumab and rituximab due to COVID-19 differ among countries. People who take these medications and are due for the next dose should consult their healthcare professional about the risks and benefits of postponing treatment. People are strongly encouraged not to stop treatment without the advice of their clinician.

Autologous Haematopoietic Stem Cell Transplantation (aHSCT) includes intensive chemotherapy treatment. This severely weakens the immune system for a period of time. People who have recently undergone aHSCT should consider extending the period they remain in isolation during the COVID-19 outbreak to at least six months. People who are due to undergo treatment should consider postponing the procedure in consultation with their healthcare professional. If aHSCT is given, chemotherapy should be administered in rooms isolated from other hospital patients.

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