#MSCOVID19 webinar have you registered?

This week I am participating in a debate on how to manage patients with MS on DMTs during the COVID-19 pandemic. Rather than a didactic lecture, I am going to debate several issues with Dr Kerstin Hellwig in relation to two case scenarios (see below), which will highlight the evolving complexities of how to manage MS during these troubling times. If you haven’t registered yet please do so ASAP as places are limited.

Case 1: A 36-year old male has been on ocrelizumab for 2 years; this is his second DMT after having previously received interferon β-1a. He was due his 6th dose of ocrelizumab in March 2020 but this has been postponed indefinitely by his MS centre.

Do you agree with this decision?

What are his chances of getting severe COVID-19 with B-cell depletion?

What about secondary bacterial infections in the event he does get COVID-19?

When will it be safe to resume ocrelizumab treatment?

He is worried that on ocrelizumab therapy he will be unable to show response to an anti-SARS CoV-2 vaccine? Is this a factor to consider when reviewing his treatment?

Would you consider switching his treatment to allow him to be ‘vaccine-ready’ and if yes to what therapy would you switch?

Case 2: A 28-year old woman with highly active RRMS. Previously suffered relapses on dimethyl fumarate in the past. She was treated with oral cladribine in June and July 2019. She is due her second course in late June and July 2020. She had been told be her treating neurologist that she should delay her next course of treatment until after the COVID-19 pandemic is over.

Do you agree with this decision?

How effective is one course of oral cladribine and will it be sufficient to protect her during the current pandemic?

If she received her 2nd year of oral cladribine should she be shielded and for how long?

Could measuring her lymphocyte counts assist in management of this patients?

What is a safe lymphocyte count?

Would delaying her second course of oral cladribine affect her ability to be vaccinated with an anti-SARS-CoV-2 vaccine in the next 12-24 months?