Discussions in the Brain Exchange chat rooms

Dr Agne Straukiene reported on the peer-to-peer discussion held on 12th September. Discussions were surrounded elements of care within the context of the coronavirus pandemic.

Discussions in the chat rooms began around B-cell depletion therapy and whether MS services should be providing this at present. Key comments included whether we should start / stop / complete cycles of medicines.

• There has been a period of time with little or no activity in prescribing B-cell depletion therapies in many parts of the globe.
• Criteria has now eased and some tablet forms have been continued
• Recent studies have suggested that CD4 and CD8 reduction is transient and therefore safe for use during the COVID-19 pandemic
• One physician present shared that she has continued to use cladribine during the pandemic
• Physicians from Brazil shared that they have not ceased prescribing cladribine at all.

In discussing future COVID-19 vaccinations and their impact on individuals on anti CD-20 and cell-depletion therapies:

• The current advice is to wait until a COVID-19 vaccine is developed and to discuss this later when we know what the vaccine epitopes themselves are like.
• It was agreed in the room that starting, or continuing anti-CD therapy at present is the best course of action.

Some physicians in the USA outlined their findings in people with MS who have contracted coronavirus. Those presenting with COVID-19 and requiring admission were:

• generally older people
• those who had significant disability
• some who were on Tysabri infusions recovered well from COVID-19
• some developed an MS relapse during recovery from COVID
• some experienced pseudo-relapses as is common amongst those with MS who experience an infection
• Extreme fatigue - far more so than individual's usually reported fatigue levels - was experienced by many

Finally, discussion turned to advising patients on shielding. It was agreed that it is an individual and personalised decision and that physicians need to help people to make informed decisions balancing both physical and mental health needs.