#MSCOVID19: MS Academy Q&A session

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If you are an HCP battling to manage MS remotely under the COVID-19 lockdown, or you have any specific problems that you need help with, please don’t hesitate to register for tomorrow’s Q&A session. The feedback we have been getting about these webinars has been amazing.

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

25 comments

      • Thanks 😊
        My questions are around my ocrelizumab treatment which was due in May but has been postponed. When will it be safe to continue? What will this decision be based upon?
        Also, I’m self isolating for 12 weeks but will I be safe then if not now?
        What about my response to any future vaccine?

        • When is is safe, for some…..May I suspect…..Giovannoni G. Anti-CD20 immunosuppressive disease-modifying therapies and COVID-19. Mult Scler Rel Disord. 2020. DOI: https://doi.org/10.1016/j.msard.2020.102135 [Epub]

          What will the decision be based on…currently fear…maybe in a few weeks it will be data.

          Ocrelizumab works on the idea of permanently depleting your Bcells and so the risk is maintained, the question is this risk high or low..

          Your response to a fututre vaccine will be blunted unless people think about the biology abit

          • “immunocompromised patients in the COVID-19 cohort was 3.7x lower than that in the viral pneumonia cohort (2.3% vs. 8.5%, p<0.00001; Figure 1) (Icnarc Website, 2020). This information is likely to be biased, in that those patients deemed too frail and/or disabled with COVID-19 may never reach ITU and it may include a disproportionate number of immunosuppressed patients. At least in a non-MS population it implies that immunosuppressive therapies may be associated with better disease outcome in those with COVID-19.”

            From most recent ICNARC:

            Dependency prior to admission hospital:
            Some assistance in daily activities :
            Covid group 355 (6.9 %)
            Viral pneumonia group 1392 (24.1%)

            All of the severe comorbidities less represented in the Covid group vs the viral pneumonia cohort in the ICNARC data. Including severe cardiac and respiratory disease.

            When I read the ICNARC data I can see how it unfortunately supports the first statement from Prof but sadly not the later.

          • I am not sure being on immunosuppressive therapies makes you more likely to be frail; possibly the other way round. The point I am making is that that very few COVID-19 patients admitted to ITU are on immunosuppressed compared to patients with viral pneumonia. At the moment most HCPs, the NHS and PHE are saying being on immunosuppressive therapies puts you at higher risk of getting severe COVID-19. I am not sure this is correct. Show me the data? I suspect the opposite will emerge, i.e. patients on immunosuppressive therapies are likely to be at lower risk of getting severe COVID-19 because immunosuppression counteracts the immunological mechanisms that cause ARDS (cytokine storm, etc.).

            This is important because it would indicate that we need to start ‘mild immunosuppressive’ therapies earlier in the course of COVID-19 rather than waiting for patients to get to ITU. Once you in ITU it may be too late for the immunosuppressive to affect the inflammatory cascade. This is why pwMS on DMTs who get COVID-19 may do better than pwMS who are not on DMTs. Isn’t this an interesting hypothesis to test? At the moment we are testing this hypothesis globally as many people with MS are not being started on DMTs or having their DMTs stopped or having redosing of some DMTs delayed.

          • I posted the data from ICNARC on dependency to try and show that the Covid and Viral Pneumonia cohorts aren’t matched so drawing conclusions from comparing them is difficult.

            It could even be that people with severe comorbidities are social distancing/self isolating more diligently because of a perceived risk and actually the bias for this data occurs not at the level of triage at the doors of ICU but in the personal actions of the individual making them less likely to be infected (I have no idea if this is the actually the case and no evidence to support this statement).

  • Unfortunately, I’m not free today now. Working from home and needed to dial in for a meeting.
    Will the information be made available later?
    I had my telephone appointment with my MS nurse yesterday. She said that my neurologist is reading all the research carefully to help her decision making around when to commence ocrelizumab again. Do you think there will be a UK wide decision or could it be regional? I’m in a relatively lower COVID-19 rate area compared to others. Could this be a factor?

  • How safe is it to go back to work while making pretendolimod? Are there known cases of covid 19 making fingolimod? Thank you

        • I think it was 2-3 days in intensive care but they had the age distribution assocaited with covid problems, we are expecting Italian registry data to report very soon

          • Okay, I should wait for more data before I go back to work because I’m a lab technician in a hospital.
            Thank you

        • In the italian cohort there have been 5 deaths 1 on rituximab and 1 on dimethyl fumarate there have been 9 cases of confirmed COVID on fingolimod and another 7 suspected. Hopes that helps to ease the nerves. More information will surface this and next week

  • É seguro voltar ao trabalho com terapia com fingolimod? Sou técnica de laboratório em hospital.
    Há casos conhecidos de pessoas covid19 + a fazer fingolimod? Qual o prognóstico? Obrigada.

  • Sim, and there my Portuguese stops DrM&M can do a much better job. Yes there are cases of people having fingolimod and recovering, in China there is a trial ongoing where they are using fingolimod as a potential treatment. No reports of results yet. In the next few days I am sure we will hear details. Obviously in hospital people are being exposed to COVID-19 and there are risks, if the picture is you, young female is a good prognostic feature. I hope you have protective equipment. Stay safe and thanks for all the work you are doing.

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