Robert Fox, MDRobert Fox, MD
Updated March 13, 2020: As the global COVID-19 pandemic continues to roll on, withover 1700 confirmed cases of the novel coronavirus in the US and over 135,000 cases globally, risk of contraction has become especially relevant within the neuroimmunology community.

As many patients with multiple sclerosis, myasthenia gravis, and other neuroimmune disorders receive disease-modifying therapies (DMTs) that act on the immune system, they may face an increased risk of being infected with the virus and developing more severe symptoms.

With concern growing in the neurology community and beyond, NeurologyLive spoke to Robert Fox, MD, neurologist at the Mellen Center for MS and vice chair for research at the Neurological Institute at Cleveland Clinic, to learn more about what the hospital is doing to counsel patients through this time and provide guidance for staff to help prevent the spread of COVID-19.  

“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.
 
WATCH: Peer Exchange on Advances in Early Treatment Approaches in Multiple Sclerosis

New guidance from the MS International Federation (MSIF) suggests that "people with MS who are currently taking alemtuzumab, cladribine, ocrelizumab, rituximab, fingolimod, dimethyl fumarate, teriflunomide, or siponimod and are living in a community with a COVID-19 outbreak should isolate as much as possible to reduce their risk of infection. Recommendations on delaying second or further doses of alemtuzumab, cladribine, ocrelizumab, and rituximab due to the COVID-19 outbreak differ between 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."

The organization also pointed out that there is currently no specific guidance for women with MS who are pregnant or for the pediatric MS population. At this time, pediatric patients should follow current guidance for adults patients. 

In addition, MSIF cautioned that patients undergoing autologous haematopoietic stem cell treatment (aHSCT), which includes intensive chemotherapy, may want to take special precaution "People who have recently undergone treatment should extend the period they remain in isolation during the COVID-19 outbreak. People who are due to undergo treatment should consider postponing the procedure in consultation with their health care professional."

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 told NeurologyLive.

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.