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COVID-19 coronavirus and MS treatments

Our MS Society medical advisors are closely following what’s happening with MS treatments and COVID-19 coronavirus. This page is based on their advice, advice from the NHS and guidelines from the Association of British Neurologists.

We updated this page on Tuesday 26 May based on revised guidelines from the Association of British Neurologists (ABN). Follow links for updates to:

We know things are changing fast. This page sets out what we know about treatments right now. We’re keeping it under continual review as our knowledge of the virus improves over time. That means it's important you check this page regularly for updates

Find out about risk, staying at home, getting shopping, shielding, benefits and financial and caring support

MS disease modifying therapies (DMTs) and coronavirus

DMTs affect your immune system, which can make your chances of infection, or complications from infection, higher. These risks are different for different DMTS, but generally they are moderate.

If you're taking a DMT and think you have coronavirus, you should be able to continue taking it if your symptoms are mild.

Monitoring of DMTs

In some cases, you may get less frequent blood tests to monitor your DMT. Centres will try to avoid any delays to blood tests, but the Association of British Neurologists (ABN) has published changes they judge are safe if your centre can't provide the usual number of tests because of their coronavirus response. We’ve added this ‘recommended monitoring’ below, to the information on each DMT available on the NHS.

Delivery of DMTs

If you have homecare services for delivery of your DMT, generally these should carry on without a problem. If they are delayed or you have any difficulties contact your MS team immediately.

Visit the National Clinical Homecare Association for information about homecare and coronavirus

Read what to do if you think you have coronavirus COVID-19

Local risk of COVID-19 and DMTs

In many cases the advice from the ABN is now based on the level of risk of COVID-19 infection in your local areas. The risk of infection matches the colour-coded COVID alert levels used by the UK government in England:

“Very high local risk” of infection =  level 4 and 5  

“High local risk” = 3

“Low local risk” = level 1 and 2

Your MS team will be able to find out the level of risk in your area.

In general, before cancelling a course of treatment it’s important you first discuss it with your neurologist or MS team. It may be that once you understand the risks you want to continue, or there might be an alternative DMT you can take for the time being.

Here's what we know right now about specific DMTs.

Glatiramer acetate (Copaxone and Brabio), teriflunomide (Aubagio), dimethyl fumarate (Tecfidera), beta interferons, and natalizumab (Tysabri)

Glatiramer acetate (Copaxone and Brabio), teriflunomide (Aubagio), dimethyl fumarate (Tecfidera) and beta-interferons (various brand names) do not significantly increase your risk of infection as they don’t suppress your immune system. You can take them even if there’s a very high local risk of infection.

General advice for people on natalizumab (Tysabri) infusions is to still attend your appointments when you can. As with all DMTs you should speak to your MS team if you are worried about being able to continue treatment. If there’s a very high local risk of infection, the infusion should happen where there’s less risk. For example, some centres are moving infusions to specific sites which reduce your risk of coming into contact with anyone with COVID-19 symptoms.

Recommended monitoring until the risk of coronavirus is clearer or has passed:

  • glatiramer acetate (Copaxone and Brabio), none required
  • teriflunomide (Aubagio), every month for the first 6 months, then every 4 months if stable
  • dimethyl fumarate (Tecfidera), every 6 months if stable and your lymphocyte count is above 0.5
  • beta interferons, 3 months after starting then none required
  • natalizumab (Tysabri), every 6 months testing for JC virus (the virus that can cause PML)

Fingolimod (Gilenya)

Fingolimod (Gilenya) may moderately increase your chances of viral infection, including COVID-19. However if you’re already taking fingolimod, stopping can lead to rebound MS disease activity. This could outweigh the risks of the virus. So whatever your local risk, you and your MS team might decide it’s ok to use. If the risk is ‘high’ or ‘very high’ in your area, your team are likely to be more cautious, but this wouldn’t rule it out completely.

If you’re thinking about beginning a course of fingolimod soon, you and your neurologist could consider an alternative DMT for now.

Recommended monitoring until the risk of coronavirus is clearer or has passed:

  • every 6 months in first year, then every 12 months if stable

Alemtuzumab (Lemtrada)

You should usually only take a course of alemtuzumab (Lemtrada) if the local risk of infection is low. This is because this treatment can increase your risk of viral infections, especially in the few months following treatment.

If the local risk of infection is high or very high, you and your neurologist should consider delaying it. The case for waiting could be particularly strong if you’re scheduled for a second or third course of treatment. A delay of a few months is relatively unlikely to affect the clinical progression of your MS.

If you take a course of alemtuzumab you should self-isolate at home for 12 weeks.

Read what to do if you've recently had an infusion of alemtuzumab

Recommended monitoring until the risk of coronavirus is clearer or has passed:

  • every 3 months

Cladribine (Mavenclad)

You and your MS team can consider taking cladribine (Mavenclad) whatever the local level of risk. But if the risk of infection is very high, your neurologist might think the risk outweighs the benefits and recommend that you delay treatment.

If you’re scheduled for a second course of treatment, a delay of a few months is unlikely to affect the clinical progression of your MS.

If you take a course of cladribine you should self-isolate at home for 12 weeks.

Read what to do if you've recently had a course of cladribine

Recommended monitoring until the risk of coronavirus is clearer or has passed:

  • 2 months after starting. If this shows you’re stable and have a lymphocyte count above 0.5, a test scheduled for 6 months after starting can be delayed. 

Ocrelizumab (Ocrevus)

Ocrelizumab (Ocrevus) is a highly effective treatment for MS but can also moderately increase your risk of viral infection.

For relapsing MS, if your local risk of COVID-19 infection is low, the ABN says it’s reasonably safe to use. If the risk is high, the ABN says it can be used cautiously. If the local risk is very high, they don’t rule it out completely, but do say it ‘may be used rarely’.

If you’ve already taken it and are scheduled for a follow-up infusion your neurologist may recommend you delay this if there is very high local risk of infection. A delay of a few months is relatively unlikely to affect the clinical progression of your MS.

For primary progressive MS, ocrelizumab is only recommended if the local risk of infection is low. This is because there are often higher risks from COVID-19 for people with primary progressive MS, like more advanced disability or other health conditions as well as MS.

Recommended monitoring until the risk of coronavirus is clearer or passed:

  • none required

Siponimod (Mayzent), ofatumumab (Arzerra) and rituximab

Siponimod (Mayzent), ofatumumab (Arzerra) and rituximab (various brand names) are not available on the NHS, but some people get them by private prescription in the UK. These drugs could also affect your risk of getting COVID-19. If you’re taking any of them you should discuss your treatment with your neurologist or health professional.

Haematopoietic stem cell transplantation (HSCT)

HSCT is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells. This treatment has a big effect on your immune system for a period of time. You and your neurologist and transplant team should consider delaying this treatment unless the local risk of infection is very low (meaning no known cases locally).

If you've had HSCT treatment in the last 12 months, speak to your transplant team about self-isolating. They may recommend you carry on for longer than 3 months post-treatment.

Read what to do if you've recently had HSCT

Steroids for MS relapses and coronavirus

Whether you should take steroids or not depends on your specific circumstances and how severe your relapse is. You should discuss it with your neurologist or MS team.

MS clinical trials and coronavirus

Advice about clinical trials will be different depending on what you’re testing. So you’re always best to speak directly to your trial team about it.

If you’re diagnosed with coronavirus COVID-19

If you think you have coronavirus and are taking a DMT, you should be able to continue taking it if your symptoms are mild.

If you're advised to go to your local hospital by any health professional, or go to hospital for any other reason, you should alert you MS team (even if you are not admitted). If you are taking a DMT they may want to discuss pausing or switching your treatment for the time being.

Can I treat coronavirus COVID 19 with ibuprofen?

The UK government has looked into this and says you can take paracetamol or ibuprofen when self-medicating for symptoms of COVID-19, like fever and headache, and follow NHS advice if they have any questions or if symptoms get worse.

We updated this page on Tuesday 26 May 2020.

Help prevent outdated information sharing

We're constantly updating our information on coronavirus. So if you want to share it, please link to the page directly rather than quoting or summarising what we’ve said.

More information

Go to our MS and coronavirus care and support page

Read the latest research on coronavirus and MS

Go to the UK government coronavirus page

Go to the NHS 111 coronavirus service

Read the ABN coronavirus guidelines

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