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Management of Multiple Sclerosis in the Era of COVID-19 Pandemic - Episode 6

MS COVID-19/Vaccine Advice

Klaus Schmierer, MB BS, PhD, FRCP, concludes with advice for community physicians and neurologists who are managing patients with MS and COVID-19 or vaccinations.

Klaus Schmierer, MB BS, PhD, FRCP: As general advice for colleagues in the community, I would say it is important to vaccinate. Keep people really vaccinated for all the conditions that they're eligible for, but certainly, for SARS-COV-2. Give them their third or, in fact, fourth vaccination where available—of course according to the respective criteria usually issued by the state. Vaccination is really fundamental. I would also advise to continue the protective measures: mask-wearing, social distancing where possible, avoiding crowded rooms, particularly in the current climate where the Omicron [variant] is still around. Although it causes fewer hospitalizations and fewer deaths, there is still a significant minority—and particularly people with immune conditions or other comorbidities—that are at risk. So for anyone in that community, this is therefore useful or remains useful. I think a further element to flag is that—in terms of the treatments that are available at this point, and that includes sotrovimab, molnupiravir, Paxlovid [nirmatrelvir/ritonavir], and remdesivir—that all of these can be combined with the current disease-modifying treatments. There was a concern about ritonavir as an element of Paxlovid [nirmatrelvir/ritonavir] in S1P [sphingosine-1-phosphate] modulators. And so we've looked at this and also had discussion with colleagues from Novartis [Basel, Switzerland, [and] overall our impression is that there's no excess risk. There is concern about liver metabolism. The inhibition of the CYP3A4 may affect a level-A of the drug, as in fingolimod, siponimod, or the efficacy of the antiviral drug, but given the brevity at which these drugs are being given, we don't think this is of clinical relevance. The fundamental point remains all treatments can be combined with the currently available disease-modifying treatments from my perspective.

This transcript has been edited for clarity.