Do DMTs Increase the Risk of COVID-19 for MS Patients?

July 13, 2020

Are patients with MS taking DMTs at higher risk of infection or case severity during COVID-19? A small study suggests that may not the case with one.

Patients with multiple sclerosis (MS) who are taking alemtuzumab (Lemtrada) may have milder symptoms when infected with coronavirus disease 2019 (COVID-19), according to a small study of 10 patients with relapsing-remitting MS. The study offers new data on what is a complicated question for physicians: How to best treat patients with MS given concerns that some disease-modifying therapies (DMTs) might render patients more susceptible to COVID-19.

Kathleen Costello, MS, ANP-BC, MSCN, associate vice president for healthcare access at the National Multiple Sclerosis Society, noted that international guidelines recommend patients with MS who are taking DMTs continue taking those treatments, but added that physicians and patients need to be vigilant. "Those people on certain DMT’s that deplete immune system cells should be vigilant with precautions to reduce the spread of the virus, such as wearing a mask in public, frequent and thorough handwashing, social distancing, and avoiding crowds or large gatherings," she said.

In the new study, published in the journal Multiple Sclerosis and Related Disorders, corresponding author Jordi Matias-Guiu, M.D., Ph.D., and colleagues noted that there was a lack of consensus about DMTs in the earliest days of the pandemic. Some guidelines suggested temporarily delaying treatment with immunosuppressive DMTs, particularly if the DMT in question was associated with depletion of lymphocytes. The fear was that such patients would be left more vulnerable to COVID-19.

To investigate the question, Matias-Guiu and colleagues at the Hospital Clínico San Carlos in Madrid telephoned 10 patients with RRMS and asked them questions about their MS, as well as questions about potential COVID-19 symptoms and potential symptoms among members of their households.

Of the 10 patients included, 80% were female and the mean time since diagnosis was 17.3 years ± 8.59 years). The average time since the last dose of alemtuzumab was 9.8 ± 6.64 months, and the last lymphocyte count was 760 ± 231/μL.

Two of the patients had symptoms such as fever, diarrhea, and headache that the authors believed were likely associated with COVID-19. Neither patient had been evaluated by RT-PCR, though one patient later had a positive serological test. However, neither required hospitalization, and both patients’ symptoms were generally categorized as mild and the length of symptoms appeared to be short. The authors also noted that another participant lived with someone who had contracted COVID-19, and yet that participant did not show any symptoms of the disease.

“Although there are few cases, the feeling is that patients who are under treatment with alemtuzumab do not have different risk than the population,” Matias-Guiu told Managed Healthcare Executive

In the study, he and colleagues suggested the apparent lack of a heightened risk might be because immune reconstitution sparked by alemtuzumab might make the patient’s immune system stronger against SARS-CoV-2, the virus that causes COVID-19.

Matias-Guiu said his team has another article, currently under review by a journal, which affirms these findings, though he said the confidence intervals remain very wide due to the low number of cases.

Matias-Guiu said it’s still very early and the data that exists are mostly based on small or short-term studies. He said a number of questions and potential explanations still need to be evaluated. For one, he said the fact that MS patients don’t appear to be at a higher risk of infection than the general population may be unrelated to the disease itself and instead be a result of these patients being less exposed to the virus. For now, though, he said early fears have not been supported by the data.

“Obviously, more studies will come out, but in any case, it does not seem that there should be an additional fear [about MS patients taking DMTs] to that of the rest of the population,” he said.