Table 2.
International expert opinion on potential impact on the clinical course of a Covid-19 infection of pharmacologic disease-modifying therapies (DMT) in current use within the management of multiple sclerosis (MS).
| Source of opinion | |||
|---|---|---|---|
| DMT | MS International Foundation (2020) | Association of British Neurologists (2020) | St Bartholomew's Hospital, UK (Giovannoni et al., 2020)a |
| Interferon beta | Unlikely to have negative impact on a Covid-19 infection | May be used when and where rates of SARS-CoV2 infection are very high (these drugs do not specifically increase the risk of infection) | Very low risk of adverse impact |
| Glatiramer acetate | |||
| Dimethyl fumarate | Limited evidence suggests no increased risk of severe COVID-19 symptoms or death | Low risk of adverse impact | |
| Teriflunomide | Very low risk of adverse impact | ||
| Fingolimod, siponimod | Use cautiously at very high rates of SARS-CoV2 infection (possible increased risk of viral infections) | Intermediate risk of adverse impact | |
| Anti-CD20 (ocrelizumab, rituximabb) | Possibility of increased risk of admission or intensive care due to Covid-19 | Use cautiously in RRMS where rate of SARS-CoV2 infection is very high. Consider delaying re-treatment until very high infection rates reduce.c | Intermediate-to-high risk of adverse impact |
| Cladribine tablets | Insufficient data are available to make an assessment at this time | Start cautiously on case-by-case basis when SARS-CoV2 risk is very high. Delay re-treatment until infection risk is low or moderate | Intermediate risk of adverse impact |
| Natalizumab | Used if rates of SARS-CoV2 infection are very high if individual's risk of PML is acceptable | Intermediate risk of adverse impact | |
| Alemtuzumab | Only start or retreat, when SARS-CoV2 risk is low, except on case by case basis | High risk of adverse impact | |
St Batholomew's Hospital additionally classified mitoxantrone and autologous haemopoietic stem cell transplantation as “High” risk. bRituximab is not indicated for the management of MS: ocrelizumab and rituximab are included together here as these agents share a common mechanism of action and rituximab is used frequently off-label for the management of MS. cAdditionally, use ocrelizumab in people with PPMS with higher levels of disability, only when the risk of SARS-CoV2 is low, except on a case by case basis, as these patients are more likely to have comorbidities and the risk:benefit ratio of treatment is likely to be reduced. PML: progressive multifocal leukoencephalopathy. Expert opinion has been paraphrased for brevity and clarity.