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MouseDoctor

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      The question was whether alemtuzumab is the same as ocrelizumab and cladribine in terms of risk to COVID and I was asked to argue no. The current ABN guideline is that these three should not be started and delayed, whilst I am not going to say what I think, I do make the point that cladribine can use used in such a way that the need to go into hospital is avoided, as this obviously going to be a hotbed of COVID.

      I argued that cladribine is closer to the action of ocrelizumab than it is to alemtuzumab and therefore loses some of the infection risks of alemtuzumab, and whilst not talked about so much ask cladribine is not given for ever it avoids some of the infection risks of ocrelizumab and continuous B cell depletion.

      So I went through what I have learned about the biology of the infection and is suggests that macrophages and CD8 cells are important for viral immunity on first infection as alemtuzumab targets these cells more so than cladribine and ocrelizumab. Antibodies may be important to stop re-infection.

      Surprsingly you actually may benefit from being on a DMT.

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