Professor Gavin Giovannoni has published a commentary paper on ‘The COVID-19 pandemic and the use of MS disease-modifying therapies’ in Elsevier.
During the coronavirus pandemic, one of the biggest areas of discussion and concern amongst the multiple sclerosis (MS) community has been around disease-modifying therapies. From what to begin and how, to safe monitoring, to the risks of patients following treatment, the questions have flown fast and furious from both professional and patient populations.
Advice from the Association of British Neurologists (ABN) is continually being updated, the most recent changes published on 4th April. Practical advice on how to provide DMTs effectively and safely in varying localities is vying with individual health services capacities and availability.
This paper sets out the professional views of Gavin and some of his international colleagues. In summary of the paper, the final paragraph provides a good overview:
‘Clearly, any decision to start a DMT during the COVID-19 pandemic will need to be taken carefully and will depend on the state of the COVID-19 pandemic, not only in the particular country concerned, but in the specific area the patient lives and receives therapy. For example, aggressive public health steps to contain the spread of the virus locally may make it relatively safe for a patient to start an immunosuppressive therapy. Our concern is that the COVID-19 pandemic may trigger a large number of neurologists and patients to reconsider treatment strategy and choice of initial DMT and to opt for less effective immunomodulatory DMTs. This change needs to be considered carefully.
The COVID-19 pandemic in all likelihood will be short lived and it would be unfair to patients treated during the epidemic to be disadvantaged in the long term regarding the management of their MS. Neurologists have spent an extraordinary amount of time and effort to activate the MS community: to advance the principle that ‘time is brain’, to treat MS proactively to a target of no evident disease activity (NEDA) and more recently, to flip the pyramid and use higher efficacy treatments first line. These treatment principles are evidence-based and should not be thrown out in the context of a potential, but yet undefined, risk to our patients.’
The full article can be found online whilst webinar discussions around disease-modifying therapies and their use during the pandemic deal with responses to varied questions from a variety of expert professionals.