Thanks to @drruthdobson I’ve just received the new ABN guidance on MS disease modifying treatment during the COVID-19 crisis. This updates last week’s document shared here: https://multiple-sclerosis-research.org/2020/03/abn-guidance-on-dmt-in-the-times-of-covid-19/.ABN-Guidance-on-DMTs-for-MS-and-COVID19-APPROVED-18-March-v-3
The main change is related to NHS England having relaxed the eligibility criteria for natalizumab (Tysabri) in order to enable using the drug instead of immune reconstitution therapies (Alemtuzumab, Cladribine, Ocrelizumab) for people with highly active disease whilst the pandemic spreads.
There is additional guidance for neurologists and MS specialist on what to do if MRI is not available, or not encouraged at their Trust current time. Here’s @AlasdairColes’s technical comment that came along with the new document: “I am aware that many centres are trying to reduce the number of unnecessary MRIs … So, in our current extreme situation, if you do feel a MRI is redundant to your assessment, you might consider ticking the BlueTeq box which states ‘comparator MRI is unavailable or assessment of gadolinium-enhancement is unreliable as the patient was treated with steroids at around the time of scan.'”
The new advice also includes comments on stopping DMT, and I expect this to evolve as we understand the virus and pandemic better. Particularly if you are on Fingolimod or Natalizumab, the risk of stopping needs to be monitored closely and balanced against the risk of rebound disease, so stay in touch with your team to discuss these issues.
@neurognanapavan highlighted some imprecision regarding neurological symptoms due to COVID-19 in the new ABN document, and as one of the readers pointed out, @gavingiovannoni discussed this paper on the Blog yesterday:Li_et_al-2020-Journal_of_Medical_Virology
Finally, another plea to sign-up to the UK MS Register. Our friends in Swansea have added questionnaires related to COVID-19 so please keep visiting the site, sign-up and help tracking the virus among pwMS https://ukmsregister.org.