COVID-19 and MS: Medication Tips for Patients
Many patients with multiple sclerosis who take drugs that suppress their immune system wonder how to stay safe during the pandemic. Our expert makes these recommendations.
Current data suggest that having multiple sclerosis (MS), in and of itself, does not mean you are at higher risk of getting COVID-19 or being more severely ill if you do get it. But it does mean that if you do contract it and spike a fever, it could cause an MS flare up or “pseudoexacerbation,” a temporary worsening of symptoms because of a known cause and not because of new damage or progression of the disease. So, like the general population, people with MS are encouraged to follow strict CDC precautions in terms of social distancing and hygiene.
Disease-Modifying Therapies
The current recommendations are that people with MS should not stop taking their disease-modifying therapies (DMTs), although for patients on some DMTs, this may have to be decided by their doctors on an individual basis. Some medications suppress the immune system more aggressively than others, including alemtuzumab (Lemtrada), cladribine (Mavenclad,) ocrelizumab (Ocrevus), and rituximab (Rituxan), which are thought to be more likely to increase the risk of becoming infected. Some providers may recommend delaying a scheduled infusion or treatment for these medications, but there are no uniform guidelines for this at this time.
Older therapies such as beta interferons (Avonex, Betaferon, Extavia, Plegridy, Rebif) and glatiramer acetate, and natalizumab (Tysabri), which does not act on the peripheral immune system, are not expected to increase risk for infection. Teriflunomide (Aubagio), dimethyl fumarate (Tecfidera, Vumerity), fingolimod (Gilenya), and siponimod (Mayzent) might increase risk for infection.
Flareups
If you experience an acute exacerbation of MS symptoms during this time, a brief course of steroids may be given, if necessary. If it isn’t feasible to get a steroid infusion, your doctor may prescribe equivalent high doses of oral steroids, which studies have shown are equally effective and generally well tolerated. Experts also recommend treating fevers aggressively.
Staying Well
It’s important to take especially good care of yourself at this time to maintain general wellness. Since most gyms are closed, try to continue a workout regimen at home or in your neighborhood (with appropriate physical distancing). Meditation and stress reduction techniques are also helpful in dealing with increased stress and anxiety.
Doctor Visits
Talk to your doctor about whether it’s advisable to postpone routine lab tests or MRIs during this time, to avoid possible exposure to COVID-19. Many practitioners are scheduling virtual office visits with their MS patients via phone and/or video link for this reason. And be sure to have a supply of medication on hand, preferably at least a month’s worth.
Dr. Giesser is professor emeritus of clinical neurology at the David Geffen School of Medicine at UCLA in California, a staff physician at Pacific Neuroscience Institute, and a member of the Brain & Life editorial board.
Read More:
COVID-19 (Coronavirus) and Neurologic Disease Resource Center
