MS and COVID-19: The Use of Disease-Modifying Therapies

Transcript:

Florian Thomas, MD: Good morning. I'm Dr Florian Thomas. I'm the chair of the Department of Neurology at Hackensack University Medical Center and Hackensack Meridian School of Medicine. I'm also the founder of the MS Center at Hackensack University Medical Center and of the Hereditary Neuropathy Center.

Since the beginning of the pandemic, physicians and patients have struggled with the potential need to modify how we view the use of so-called disease-modifying drugs, or disease-modifying therapies, for multiple sclerosis.

The question that presented itself initially was whether the fact that a person with multiple sclerosis is on an immune-modulating, disease-modifying drug would possibly increase their risk of becoming ill from COVID or would possibly make infection worse once they got it.

Our thinking on these 2 questions has certainly evolved over the last 9 months. There were those among us who initially thought that it might be prudent to delay initiating medications. It might be prudent to possibly withhold medications.

Any such concerns need to also take into account the effect that delaying medications or using medications that are less intense in their effect on the immune system might have on patients. We have now diligently gathered data on outcomes of patients with multiple sclerosis during this pandemic.

Overall, our concerns that using disease-modifying drugs in patients with MS might put patients at risk for severe COVID or even just on getting COVID in the first place–those concerns have largely not been warranted.

It appears that the outcomes of patients with multiple sclerosis on disease-modifying drugs has not been worse than the outcomes of patients on the least immune-modulating drugs of patients compared to the general population. That's been very reassuring.

We have some thoughts why this is the case. That is to say why patients on disease-modulating drugs have done reasonably well even when they acquired COVID.

Firstly, the more we learn about COVID, the more we understand that while it is an infectious illness that requires an immune response in order to fight it, quite often, the manifestations of COVID, especially of serious COVID, reflect an overactive immune system and overactive immune response.

There have been various attempts to attenuate the immune response, including with medications that are otherwise also used to treat a variety of autoimmune diseases.

Looking at how the disease-modifying drugs affect the immune system in multiple sclerosis, several of these drugs very much use a stiletto approach. They affect a particular component of the immune system and largely leave the rest of the immune system alone.

That may be one of the reasons why people with MS do quite well even if they are on immune-modulating drugs. That is to say the rest of the immune system is capable of fighting a COVID infection.

Interestingly, some of the drugs we use in multiple sclerosis have been considered as treatment for COVID. I specifically refer to a class which represents the oldest FDA-approved class of drugs for multiple sclerosis, the interferon betas. Their treatment approach is underway that use interferon betas to fight COVID.

The immune system is very complex. It turns out that people do well even if one component of the immune system has been modified by disease-modifying drugs.