There remains uncertainty regarding current levels of Covid-19 and the level of risk it poses to
people with multiple sclerosis (pwMS). Since the previous Association of British Neurologists (ABN)
guidance was published in November 2020 there has been a mass Covid-19 vaccination programme
with excellent uptake in pwMS and most recently the removal of legally mandated restrictions on 19
July 2021. The following advice has been updated in the light of further data in both pwMS and in
other therapy areas.
The main points are:
- All DMTs should be available to pwMS during the Covid-19 pandemic, provided that the
benefits of treatment outweigh their risks. Local rates of infection, the individual’s general
health and their risk of exposure to the virus should be considered in the DMT choice.
- Studies to date are reassuring, showing no additional Covid-19 severity risk for pwMS from
all disease modifying therapies (DMTs) with the possible exception of anti-CD20 monoclonal
antibodies (ocrelizumab and rituximab). Even with this group of DMTs the risk appears small
and should be taken in context with the potential benefit of the therapy.
- In general, pwMS with mild symptoms of COVID-19 should not stop their DMTs. Certain
therapies (infusions and cladribine) should be delayed until symptoms resolve. In cases of
severe infection, the DMT should be stopped and the prescribing team urgently consulted
for further advice.
- We continue to encourage, all pwMS (unless contraindicated) to have the Covid-19
vaccination when offered. All pwMS should be offered a Covid-19 ‘booster’ vaccine when
- It is possible that some DMT classes: sphingosine receptor modulators (fingolimod and
Siponimod) and CD20 agents (ocrelizumab, rituximab and ofatumumab) reduce antibody
production following Covid-19 vaccination. This may, but remains unproven, reduce the
efficacy of the Covid-19 vaccine. However, this would not increase any risk associated with
the vaccine and therefore we would still strongly encourage pwMS on these DMTs to have
- Some pwMS should be considered as ‘Clinically Extremely Vulnerable’ based on age (usually
over 65), higher disability (EDSS>6 and/or with swallowing or breathing difficulties) and
presence of additional significant co-morbidities. Particularly when background rates of
Covid-19 infection are high, people who meet these criteria are advised to follow the most
up to date government guidance (see section A).
- Except in the most extreme phases of the pandemic, where healthcare systems are
threatened to be overwhelmed, MS teams should be fully resourced with MS specialist
neurologists, nurses and allied health professionals.
- The effect of DMTS on the risk of SARS CoV2 infection and Covid19 disease remains
uncertain and we commend pwMS and MS teams to continue to submit data to registries
and research studies, especially the MS Register Covid study