This article describes consensus recommendations from an expert group of neurologists from the Arabian Gulf region on the management of relapsing
multiple sclerosis (RMS) in the
COVID-19 era. MS appears not to be a risk factor for severe adverse
COVID-19 outcomes (though patients with advanced disability or a progressive phenotype are at higher risk). Disease-modifying
therapy (DMT)-based care appears generally safe for patients with MS who develop
COVID-19 (although there may be an increased risk of adverse outcomes with anti-CD20
therapy).
Interferon-β,
teriflunomide,
dimethyl fumarate,
glatiramer acetate,
natalizumab and
cladribine tablets are unlikely to increase the risk of
infection;
fingolimod, anti-CD20 agents and
alemtuzumab may confer an intermediate risk. Existing DMT
therapy should be continued at this time. For patients requiring initiation of a DMT, all currently available DMTs except
alemtuzumab can be started safely at this time; initiate
alemtuzumab subject to careful individual risk-benefit considerations. Patients should receive vaccination against
COVID-19 where possible, with no interruption of existing DMT-based care. There is no need to alter the administration of
interferon-β,
teriflunomide,
dimethyl fumarate,
glatiramer acetate,
natalizumab,
fingolimod or
cladribine tablets for vaccination; new starts on other DMTs should be delayed for up to 6 weeks after completion of vaccination to allow the immune response to develop. Doses of the Oxford University/AstraZeneca
vaccine may be scheduled around doses of anti-CD20 or
alemtuzumab. Where white cell counts are suppressed by treatment, these should be allowed to recover before vaccination.