Stakeholders Discuss Impact of COVID-19 on MS Patients

Robert Fox, MD

The article, “COVID-19: Preventive Measures in Multiple Sclerosis Patients and Others on Immuno-Modulators,” was originally published on NeurologyLive.

With COVID-19 wreaking havoc across the globe, patients with multiple sclerosis, myasthenia gravis, and other neuroimmune disorders receiving disease-modifying therapies (DMTs) may be particularly at risk for infection and more severe symptoms due to compromised immune systems.

Robert Fox, MD, neurologist at the Mellen Center for MS and vice chair for research at the Neurological Institute at Cleveland Clinic, explained in an interview with NeurologyLive what hospitals are doing to counsel patients through the pandemic, while providing guidance to staff to help prevent the spread of the virus.

“At this point, the Mellen Center at the Cleveland Clinic is recommending that patients not cancel, interrupt, or delay scheduled doses of their MS medication. We believe that the way the medications work, the duration of action of these medications, and the risks of MS disease activity coming back are all reasons to continue MS therapies without interruption,” Fox said. “Given what we know about the current risks of COVID-19, MS therapy interruptions appear more likely to be harmful than helpful.”

This sentiment is echoed by several other MS centers including Stanford’s Multiple Sclerosis and Neuroimmunology Program, which has advised patients that “there is no reason to change or avoid medications pertaining to the treatment of multiple sclerosis. The CDC standard recommendations for minimizing exposure risk remain in effect.”

The National Multiple Sclerosis Society has also provided guidance for patients, advising that if they are currently taking a DMT and are concerned about COVID-19, “do not stop your DMT without first speaking with your MS provider.”

In terms of preventive measures, Timothy Vartanian, MD, PhD, director of the Judith Jaffe Multiple Sclerosis Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, advised in a posted notice on the hospital's website that “there are no formal recommendations at this time for use of masks in immune suppressed patients who are in the community. We will update you on the potential benefits of a facemask if you are on a potent immune suppressing or modulating agent.”

In the event that a patient reports symptoms associated with COVID-19, “we recommend immediate evaluation by the patient’s primary care physician or local health department. Holding MS therapy during that evaluation seems prudent as that only takes a few days,” Fox said.

Cleveland Clinic is among many institutions encouraging patients to utilize telemedicine platforms to maintain their clinical management schedule with their provider.

“We recommend our patients stay home if they are sick and instead use virtual visits to check in with us regarding their MS,” Fox said.

In order to manage the influx of inquiries, Fox said the institution provides a standard response that reiterates the CDC recommendations “regarding hand-washing, good cough etiquette, avoiding close contact with people who are sick — all the standard things that are applicable to everyone.”

In addition, Fox noted that Cleveland Clinic is routinely updating information on the virus on their main website, where patients can learn more about general preventive measures and receive instructions on what to do if they feel unwell.

For the latest updates on COVID-19, visit our sister site Contagion Live.