Every person with multiple sclerosis (MS) is advised to pay particular attention to the guidelines below for reducing the risk of COVID-19 infection.
Caregivers and family members who live with, or regularly visit, a person with MS should also follow these recommendations to reduce the chance of bringing COVID-19 infection into the home.
How can I reduce the risk of catching COVID-19?
Patients with MS should follow national guidance to help reduce the risk of catching the virus.
For further information, please contact your MS nurse.
Should I continue to take my medication?
Many disease modifying therapies for MS work by suppressing or modifying the immune system. Some MS medications might increase the likelihood of developing complications from a COVID-19 infection but this risk needs to be balanced with the risks of stopping treatment.
Our recommendations and further guidance is as follows:
- People with MS currently taking MS treatments should continue with their treatment
- Before starting a new MS drug, people with MS should discuss which therapy is the best choice for their individual disease course and disease activity in light of COVID-19 with their MS care provider
- Drugs which do not reduce specific immune cells (lymphocytes) include:
- Glatiramer Acetate
- Medications that reduce lymphocytes over longer intervals, and therefore may moderately increase the risk ofCOVID-19 infection and its complications include:
- Medications that may reduce the ability of the immune system to respond to an infection include:
- Dimethyl Fumarate
- People who are taking the following medications and are due for the next dose should consult their MS care provider about the risks and benefits of postponing treatment:
- During the COVID-19 pandemic, we advise against autologous haematopoietic stem cell transplantation, as this severely weakens the immune system for a period of time. People due to start treatment should consider postponing the procedure in consultation with their MS care provider. People who have recently undergone this treatment should extend the period they remain in isolation during the COVID-19 outbreak
What risks are associated with MS treatments?
The list below outlines MS treatments and the risks associated with them, based on the effect of the drug on the immune system.
We recommend self-isolation only for people in the high-risk category.
People with a neurological condition with low or moderate risk might be considered high-risk if they have additional risk associated with other conditions affecting the lungs, heart, kidneys etc.
People with neurological conditions resulting in frailty, or who are frail as a result of age or other conditions are also at increased risk from COVID-19.
No increased risk
- Beta interferons (Avonex, Betaferon, Extavia, Rebif, Plegridy)
- Glatiramer Acetate (Copaxone, Brabio)
- Natalizumab (Tysabri)
- Teriflunomide (Aubagio)
- Dimethylfumurate (Tecfedera)
- Fingolimod (Gilenya)
- Ocrelizumab (Ocrevus)
Risk is higher for three months following treatment.
- Cladribine (mavenclad)
- Alemtuzumab (Lemtrada)
What should I do if I develop symptoms of COVID-19 whilst on MS treatments?
If you develop any of the symptoms listed on the NHS website, please follow the NHS guidance.
After following NHS guidance
If after following the NHS guidance on the link above, you have:
- Mild symptoms – there is no need to stop your MS treatment
- Serious symptoms – if you are asked to attend hospital for testing/admission, we recommend that you stop your disease modifying therapy (if it is an injectable or oral treatment) or delay your next infusion. Please contact your MS team as soon as possible after you have stopped your medication and they will tell you when to restart
How should I monitor my MS treatment?
It is important to continue to comply with monitoring when taking MS treatments. Your MS care provider will continue to assist with your monitoring.
Currently, our recommended minimum safe level of monitoring is as follows:
- If last infusions less than a year ago – blood tests every four weeks
- If last infusions more than a year ago – blood tests every six weeks
Fingolimod, Ocrelizumab and Cladribine
- Monitor blood tests as usual, if on treatment for more than 12 months
- If blood tests have been stable on Cladribine, blood test frequency can change from three to six monthly
- Reviewed at monthly infusion as usual
- If blood tests have been stable, blood test frequency can change from two to three monthly
- If blood tests have been stable, blood test frequency can change from three to four monthly
- If been on treatment less than a year – monitor as usual
- If been on treatment more than a year – monitoring can be deferred unless latest bloods abnormal (in which case, monitor as usual)
- Telephone review – blood tests are not needed unless there is concern
What should I do if I relapse?
If you are experiencing a relapse, please contact your MS nurse by telephone. Do not attend the hospital unless it is a medical emergency.
If steroids are deemed appropriate, please be aware that there is likely to be a higher risk for susceptibility to infection including COVID-19 for the period of steroid use and 14 days thereafter, although this period is not known for certain.
Please contact your MS nurse if you have further questions or concerns.
Due to the current COVID-19 pandemic, please bear in mind that it may take longer than usual for a response. We apologise for this in advance.