Brownlee, WJ

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UCL Discovery

journals.sagepub.com/home/msj 1267COVID-19 and high-efficacy multiple sclerosis therapies: Time for business as usual? Wallace J BrownleeDuring the Coronavirus-19 (COVID-19) pandemic, many neurologists have adopted a cautious approach to treating multiple sclerosis (MS) by delaying lympho-cyte-depleting therapies (Cladribine, Alemtuzumab, anti-CD20 agents), due to concerns that treatment may increase the risk and/or severity of COVID-19 infection.1In this issue of Multiple Sclerosis Journal, two patients are reported who received treatment with Cladribine2 or Rituximab3 during the escalating COVID-19 pandemic in Europe. Both patients were hospitalized within a month of treatment with con-firmed COVID-19 infection. Remarkably, despite severe lymphopenia due to recent Cladribine or undetectable B-lymphocyte counts from long-term Rituximab therapy, both patients only developed moderate COVID-19 pneumonia with good recov-ery. These new cases add to an increasing number of reports of favourable outcomes in MS patients receiving high-efficacy, lymphocyte-depleting ther-apies who have developed COVID-19 infection.4,5In the vast majority of people with MS, COVID-19 produces a mild illness.6 Preliminary data suggest that older age, comorbidities and more advanced physical disability are more strongly associated with poor out-comes in people with MS with COVID-19 than dis-ease-modifying therapy use.6 With falling rates of new COVID-19 infections in most countries, and reassuring reports of mild COVID-19 infection even in our most immunosuppressed patients, are we now ready for business as usual when treating MS? The answer is probably yes, and in many otherwise healthy, young adults with MS, the risks of disability worsening from delayed initiation or re-treatment with a high-efficacy treatment (or opting for a less effective treatment) will outweigh the potential risks of severe COVID-19 infection.Declaration of Conflicting InterestsThe author(s) declared the following potential con-flicts of interest with respect to the research, author-ship and/or publication of this article: Dr W.J.B. has received honoraria for educational activities and/or participated in advisory boards for Biogen, Celgene, Merck, Mylan, Novartis, Roche and Sanofi.FundingThe author(s) received no financial support for the research, authorship and/or publication of this article.References 1. Brownlee W, Bourdette D, Broadley S, et al. Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic. Neurology 2020; 94: 949–952. 2. Dersch R, Wehrum T, Fähndrich S, et al. COVID-19 pneumonia in a multiple sclerosis patient with severe lymphopenia due to recent cladribine treatment.  Mult Scler 2020; 26(10): 1264–1266.  3. Wurm H, Attfield K, Iversen A, et al. Recovery from COVID-19 in a B cell-depleted multiple sclerosis patient. Mult Scler 2020; 26(10): 1261–1264. 4. Meca-Lallana V, Aguirre C, Beatrizdel R, et al. COVID-19 in 7 multiple sclerosis patients in treatment with ANTI-CD20 therapies. Mult Scler Relat Disord 2020; 44: 102306–102306. 5. Carandini T, Pietroboni AM, Sacchi L, et al. Alemtuzumab in multiple sclerosis during the COVID-19 pandemic: A mild uncomplicated infection despite intense immunosuppression. Mult Scler 2020; 26(10): 1268–1269. 6. Sormani MP. An Italian programme for COVID-19 infection in multiple sclerosis. Lancet Neurol 2020; 19(6): 481–482.WJ BrownleeVisit SAGE journals online journals.sagepub.com/home/msj SAGE journalshttps://doi.org/10.1177/1352458520943791https://doi.org/10.1177/1352458520943791Multiple Sclerosis Journal2020, Vol. 26(10) 1267DOI: 10.1177/ 1352458520948211© The Author(s), 2020.  Article reuse guidelines:  sagepub.com/journals-permissionsCorrespondence to: WJ Brownlee National Hospital for Neurology and Neurosurgery, Queen Square, Box 83, London WC1N 3BG, UK. w.brownlee@ucl.ac.ukWallace J Brownlee Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, London, UK/National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

COVID-19 and high-efficacy multiple sclerosis therapies: Time for business as usual?

https://discovery.ucl.ac.uk/10126617/1/COVID-19%20and%20high-efficacy%20multiple%20sclerosis%20therapies%20Time%20for%20business%20as%20usual.pdf

COVID-19 and high-efficacy multiple sclerosis therapies: Time for business as usual?

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