Many of us assume that those of us with multiple sclerosis (MS) fit into those, and so many other, categories of people who may be particularly susceptible to both the viral disease and its most severe results. An article published on March 27 in the journal Multiple Sclerosis and Related Disorders compiles some of the latest medical thinking about those concerns and relays some unexpected — even hopeful — notes as well.
MS Not the Only Relevant Factor
It is early days as regards the depth of medical knowledge about this novel coronavirus (SARS-CoV-2), but as much of medicine is dealing with nothing else, much is being learned at a quickening pace. Some considerations may seem obvious if we really think about them, but MS alone isn’t as much of an issue as the effect that MS, along with other aspects of a person’s life, has on our whole lives. According to the March 27 article, “Other aspects to consider when assessing a respiratory viral infection include: smoking practices (increased cigarette smoking increases risk); ambulatory status (less mobility increases risk, especially if the patient is in a wheelchair); age (increasing age increases risk); weight (increasing weight impacts on ambulation and respiratory function); underlying respiratory illnesses, such as asthma or COPD. Also, the frequency of necessary attendance at a hospital or healthcare facility for laboratory or MRI testing, but also for infusions, may place the patient at a higher risk of exposure.” Regarding potential exposure to COVID-19 in a healthcare setting, the article advises, “Visits for MS care should preferably be done by telemedicine or phone.”
Thoughts for Doctors and MS Patients on DMTs
When it comes to disease-modifying therapies (DMTs) for MS, the article’s lead author, Professor Gavin Giovannoni, MBBS, PhD, of the Blizard Institute at Barts and the London School of Medicine and Dentistry, has charted DMT risk categories to advise doctors about starting and maintaining these drugs in the current pandemic, and even about whether to continue a DMT in the event of COVID-19 infection. You can see the table by opening the link to the whole article and scrolling to Table 1. This table is, of course, only a guide for MS practitioners and their patients. The article stipulates that “the potential hazards posed by each DMT differ and, rather than imposing a blanket rule, decisions regarding treatment should be individualized and discussed with patients. For some patients, having their MS treated and controlled may be more important than the potential danger of being exposed to and acquiring a more severe COVID-19 infection.”
Could Some DMTs Be Protective?
One upside that most people who have MS and may be concerned about COVID-19 mightn’t have expected is that some DMTs may be moderately beneficial in fighting off the infection. According to the article, “Another hypothesis being considered is that moderate immunosuppression may prevent severe complications associated with COVID-19 infection. The severe pulmonary complications of COVID-19 infection are consistent with ARDS (acute respiratory distress syndrome) caused by an over-exuberant immune response to the virus.” The article goes on to note that a number of healthcare facilities around the world are experimenting with using MS drugs to fight the virus. “Interestingly, fingolimod, a S1P modulator licensed for MS, is being tested as a treatment for COVID-19 associated ARDS (ClinicalTrials.gov identifier: NCT04280588). Interferon beta is also being trialled in COVID-19 based on its antiviral properties (ClinicalTrials.gov identifier: NCT04276688).”
Still Much to Learn Across the Board
It is important to remember that this is a new (novel) human virus, and we do not know all the implications for the general population, let alone the specifics of how it will affect those with MS. Be safe, wash your hands, stay at home as much as possible, and, if you’re concerned about your MS DMT, talk to your neurologist. Wishing you and your family the best of health. Cheers, Trevis
