Tips on treating MS and NMOSD during pandemic outlined

Multiple sclerosis

By Mardi Chapman

7 Apr 2020

Neurologists could consider a higher threshold for offering steroid treatment to patients with MS experiencing an acute relapse during the COVID-19 pandemic.

The practice tip was included in advice from an international group of MS experts, including Professor Simon Broadley from the Menzies Health Institute Queensland and Griffith University.

The article, published in Neurology, said it was unknown whether patients with MS or neuromyelitis optica spectrum disorder (NMOSD) were at an increased risk of coronavirus infection.

However given chronic use of corticosteroids was associated with an increased risk of infection, the higher threshold for use might be warranted.

The article also noted that patients should be carefully screened for symptoms of active COVID-19 infection before receiving corticosteroid treatment.

As already advised by the local AZNAN MS Neurology Group, and reported in the limbic, the benefits of continuing many MS treatments will likely outweigh the risks of stopping due to concerns about COVID-19.

However for MS drugs with a moderate risk of systemic immunosuppression, initiation could be delayed or dose intervals lengthened to balance the risk and benefits.

The authors said relapses in patients with NMOSD may be devastating therefore patients should be encouraged to stay on treatment.

“If there is a clinical need to stop or delay treatment in patients with NMOSD then moderate dose corticosteroids (e.g. prednisolone 20mg) can be used to prevent relapses in the short to medium term.”

The article said telemedicine was a validated tool for assessing disability in MS and useful for reducing non-essential hospital visits during the COVID-19 pandemic.

“Other steps to reduce hospital visits like home delivery of medications, delaying follow-up MRI scans in stable patients and reducing the frequency of routine laboratory monitoring should also be considered.”

Oral corticosteroids may be preferable to IV given their equivalent efficacy in MS. Less frequent dosing of infusion therapies would also relieve pressure on MS centres.

They added that collecting data on the impact of COVID-19 on people with MS and related disorders, and particularly the risks of a novel pathogen in patients on immunosuppressive treatments was a priority for national and international registries.

“We would recommend all neurologists who become aware of a person with MS being confirmed as COVID-19 positive notify their local registry.”

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