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AAN 2020: Multiple Sclerosis Treatment Considerations - Episode 1

Multiple Sclerosis and Risk of COVID-19

Jiwon Oh, MD, PhD: With regard to the question of whether people living with MS [multiple sclerosis] are at an increased risk of acquiring coronavirus—or if they get COVID-19 [coronavirus disease 2019], whether they are at an increased risk of developing complications—the bottom-line answer is that we don’t yet know. However, the good news is that we are now entering the third month of this pandemic, and there has been quite a bit of global communication among MS specialists around the world. Different countries are setting up COVID-19 and MS registries. People have blogs and websites sharing information from various clinics.

It’s actually quite reassuring, now that we’re nearing the 3-month mark, that generally around the world, whether it’s in Europe or North America, it does not seem that there is a significant increased risk of COVID-19 in people living with MS. As you know, the majority of people living with MS are typically on a disease-modifying treatment at 1 point in their disease course.

What’s even more reassuring is that people living with MS who have a confirmed coronavirus infection do not seem to be at a significantly higher risk of developing COVID-19—related complications. Most places are monitoring this by assessing whether patients need to be hospitalized, and if they are hospitalized, whether they need to go into the intensive care unit where they require some sort of ventilatory support.

It’s been reassuring. Many countries around the world have established registries and are sharing information, and 3 months in, there does not seem to be any sort of signal of an increased risk of COVID-19 or COVID-19—related complications.

They obviously are not perfect data, and we do need to do more rigorous studies to try to understand this better. But as an MS specialist, I think this is important information. I have been telling patients that we’re still not sure, but at the current time no alarming signal has emerged, and this is actually quite reassuring.

In terms of whether there are specific risk factors for a patient with MS acquiring coronavirus, again, it’s not quite clear, but generally what we’re doing in clinical practice is applying what we know about patients who are at risk of acquiring coronavirus or COVID19—related complications. Similar to the general population, for which we know that older age and additional comorbidities are significant risk factors, we’re kind of applying the same principles in people living with MS.

Everybody has a different cutoff of what they define as older in age, but generally for anyone above age 60 or 65, we are a little more worried about them during this time. In people who have other comorbidities, whether it’s high blood pressure, cardiac comorbidities, or other respiratory comorbidities, we are also a bit more worried. In addition, we get worried, much like the general population, if an MS patient has had close contact with someone who had a confirmed COVID-19 infection.

The other point, and we’ll probably discuss this in a bit more detail later, is that we are a bit more concerned about individuals on certain MS disease-modifying treatments who we know have a more powerful immunosuppressant effect. Having said that, based on the data that are being reported thus far, it doesn’t really seem that these higher-efficacy medications—which we think have a more powerful suppressant effect on the immune system—dramatically increase an individual’s risk of coronavirus or COVID-19—related complications when they have MS, at least as of this point.