Managing MS in the COVID-19 Era

EP: 1.Innate vs Adaptive Immunity in MS Management

EP: 2.Innate and Adaptive Immunity and BTK Inhibitors for Multiple Sclerosis

EP: 3.Role of Inflammation in MS

EP: 4.Role of High Efficacy Therapy for MS

EP: 5.Use of High-Efficacy Therapy in MS in Clinical Practice

EP: 6.Considerations for Using High-Efficacy Therapy in MS

EP: 7.Updates From ACTRIMS 2022 for Relapsing MS

EP: 8.Treating Smoldering Inflammation in MS

EP: 9.Guidance on COVID-19 Vaccines for Patients With MS

EP: 10.Response to COVID-19 Vaccines in Patients Treated With High Efficacy DMTs

EP: 11.VELOCE Study in Relapsing MS

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EP: 12.Managing MS in the COVID-19 Era

EP: 13.Future of MS With BTK Inhibitors

EP: 14.MS Diagnosis and Management Going Forward

EP: 15.Clinical Pearls for the Management of MS

Ahmed Z. Obeidat, MD, PhD: I’m going to ask you, Dr Hendin, about COVID-19’s impact on your management of MS [multiple sclerosis], such as telemedicine, selecting medications, monitoring patients, and MRIs.

Barry A. Hendin, MD: We’ve dealt with COVID-19 for a long time. Some of my earliest responses were different from my current responses, and some have remained. If you ask, “What’s the biggest change in my practice?” it’s the incorporation of telemedicine. I practice in 2 different areas, and the responses from my patients are a little different. In my university practice, I see about 50% of my patients by telemedicine, and in my private practice, I see about 20% of my patients by telemedicine.

It endures and will endure because it isn’t just about COVID-19. I have patients who live 100 or 200 miles away. The ability to see them more efficiently and without the difficulties of travel means I’m doing a service on their behalf. I have patients with significant disabilities and for whom getting to a clinic is an ordeal. For patients with disabilities, patients with phobias who are scared of being in public, and patients who live far away, telemedicine has been a welcome introduction and will endure. Also, the advent of Ocrevus means I have longer conversations with my patients because we’re talking about COVID-19 almost daily. Not with every patient, but certainly every day. We’re getting phone calls asking about COVID-19 and vaccination, requiring us to stay up to date on the evolving signature and recommendations.

Ahmed Z. Obeidat, MD, PhD: We’ve been in the pandemic for a long time, so now we’re a little more experienced about how to navigate this pandemic and what to do through telemedicine and other approaches.

Barry A. Hendin, MD: The only thing I want to add is that when I discuss therapies with patients, I need to address whether therapeutic risk, not just of infection in general but COVID-19, has an impact on my choice of therapy. I’m still using all the therapies I used before, but with a cautionary note regarding variation and risk.

Ahmed Z. Obeidat, MD, PhD: Dr Berkovich, talk about the effect of the COVID-19 pandemic on your practice with telemedicine and everything else.

Regina Berkovich, MD, PhD: We haven’t closed for a single day since March 2020 because people still get diagnosed with MS and need to see an MS specialist. We’re an essential business, so we never went into 100% lockdown. We always had clinic days open for patients with acute symptoms or new patients in need of consultation. But of course, virtual medicine became a huge part of what we do, especially at the beginning of the pandemic when it was probably a distribution of 20% clinic and 80% virtual. Now it’s more like 50/50, but I agree with Barry that virtual medicine needs to stay. It has many benefits, and it’s convenient for the patients and caregivers. This healthy combination of virtual and live medicine is the way to move forward.

Ahmed Z. Obeidat, MD, PhD: It looks like telemedicine is staying and offers convenience for some patients, whether it’s distance or degree of hardship to come to the clinic, especially for overall stable patients we’re following routinely vs patients who need to come in for a physical or neurological exam. While some physicians are talented doing it virtually, I’m not. My virtual visits are mostly to check in on my patients. But when I want to examine my patients, I bring them in to the office.

Transcript Edited for Clarity