Neurologic Symtpoms of COVID19, Rimegepant Available Via Telemedicine, Natalizumab

Neurology News Network covered the first major study evaluating neurologic symptoms in COVID19 patients, the availability of rimegepant through telemedicine platforms, and the timing of most effective natalizumab treatment in pregnant patients with multiple sclerosis.

Marco Meglio: Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus

Neurologic symptoms, including central and peripheral nervous system and skeletal muscular manifestations, are commonly reported in patients with confirmed infections of COVID-19, according to clinical data from a retrospective case series published in JAMA Neurology. The report is arguably the first multi-case series of neurologic manifestations of SARS-CoV-2. The data were extracted from electronic health records of patients treated at the Union Hospital of Huazhong University of Science and Technology in Wuhan, China, the epicenter of the pandemic. Of those infected in the study, 36.4% had neurologic manifestations, which were categorized as central nervous system manifestations, peripheral nervous system manifestations, or skeletal muscular injury manifestations. Investigators wrote “this glimpse into neurologic manifestations opens a window into neurologists’ role and places them on the front lines of the pandemic.”

Biohaven Pharmaceutical has announced that it is making its recently FDA-approved acute migraine treatment rimegepant, will become available via telemedicine after a collaboration with Cove, which focuses on providing specialized care and access for patients with migraine. Biohaven noted that this collaboration is hoping to facilitate telemedicine evaluation for this population, particularly in the midst of the COVID-19 pandemic and an increased need for virtual visits. This collaboration makes the oral agent the first branded medication available through Cove’s platform, which allows patients to consult with independent health care providers and may be prescribed migraine treatments. Biohaven also noted that this partnership with Cove expands on the existing tools it has developed to enhance access to rimegepant for the appropriate patients. Their existing offerings include a 2-dose complimentary sample pack available with a prescription, as well as a patient starter kit and a copay card—available for those who utilize Cove—that can lower some individuals’ monthly cost to $0.

Results from a study evaluating pregnant patients with active multiple sclerosis suggest that maintaining natalizumab treatment during the first trimester may reduce the risk of disease reactivation during pregnancy compared to withdrawal of treatment at conception. Researchers reported that the proportion of patients with relapse and disability progression during pregnancy were lower in the group who maintained natalizumab treatment through the first trimester than in those who stopped treatment after conception. Study authors concluded “The study suggests that continuing natalizumab until the end of first trimester may reduce the risk of disease reactivation during pregnancy in patients with active relapse-remitting MS. Future studies in larger samples are mandatory to confirm these preliminary findings. These studies would also consider extended natalizumab dosing to reduce the number of infusions during pregnancy.

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