Guidance for the use of disease modifying therapies during the COVID-19 pandemic

Stuart Schlossman#COVID-19, Multiple Sclerosis

People
with MS have asked for guidance on the use of Disease Modifying Therapies
(DMTs) during the COVID-19 pandemic. There
are numerous recommendations circulating that attempt to provide clarity and
guidance, however, differences among the recommendations have created
confusion. DMT decision making varies significantly from country to country,
ranging from highly provider-directed to a collaborative decision-making model.
The MS Coalition has endorsed global
advice
from the MS International
Federation on DMT use during the COVID-19 pandemic. Their
recommendations provide detailed guidance for the initiation and continuation
of DMTs
The
MS Coalition has also endorsed recommendations from The National MS Society’s
National Medical Advisory Committee, which believes DMT decisions should be individualized
and made collaboratively between the person with MS and his/her healthcare
provider.  These recommendations are:
  1. People
    with MS should follow CDC guidelines and
    these additional recommendations for people at higher risk
    for serious illnesses from COVID-19.
  2. People
    with MS should continue disease modifying therapies (DMTs) and discuss
    specific risks with their MS healthcare provider prior to stopping a DMT.
  3. Before
    starting a cell depleting DMT* or a DMT that carries warnings of
    potentially severe increase in disability after stopping**, people with MS
    and their MS healthcare providers should consider specific risks (e.g.
    age, comorbid health conditions, location) and benefits.
We
are continuing to monitor this quickly evolving situation and these
recommendations may be modified as data becomes available.
*
Cell depleting therapies include: Lemtrada, Mavenclad, Ocrevus and Rituxan
(used off-label in MS)
** DMTs with a warning of potentially severe increase in disability after
stopping include: Gilenya and Tysabri

*** Members of the MS Coalition include: Accelerated Cure Project for Multiple
Sclerosis, Can Do MS, Consortium of Multiple Sclerosis Centers, International
Organization of Multiple Sclerosis Nurses, MS Views and News, Multiple
Sclerosis Association of America, Multiple Sclerosis Foundation, National
Multiple Sclerosis Society and United Spinal Association

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