MS Treatment Optimization During COVID-19

Jiwon Oh, MD, PhD: In terms of how I think COVID-19 has changed the way we practice in the treatment of MS [multiple sclerosis], and looking toward the months ahead, it’s interesting. Again, we’re entering into the third month of this pandemic. Regardless of whether you’re a physician or not, your first reaction is always kind of sheer panic and fear. In those early days of the pandemic, many MS specialists were really reluctant to start disease-modifying treatments in patients, and even redose patients who on some of these lymphocyte-depleting agents. We were very reluctant to bring any patients into the hospital. We canceled all MRIs [magnetic resonance imaging tests] our patients were scheduled for.

But now that we’re learning more about coronavirus as well as what COVID-19 means for our MS patients, it seems that we’re becoming more comfortable with managing immunomodulatory and immunosuppressive medications in light of this pandemic. I think we’re finding a better way to move forward with MS care. There are all these unknowns related to COVID-19, but we do know about the clear risk of neurological disability progressing when patients with MS remain untreated or are suboptimally treated.

Another thing that’s been interesting is that many of our neurology visits have been converted to virtual visits. This is something that is actually very difficult to do in the neurology world because you can’t really examine patients accurately. But we’ve started to become much more comfortable with this and have become more creative in how we assess neurological disability in our patients using technologies like videoconferencing and other tools where we can at least partially do a neurological exam.

Overall, as the world slowly emerges from this pandemic, I think we’re going to develop more rational ways to manage patients who are on immunomodulatory treatments. The forced virtual care aspect will actually change how we approach clinical visits, even when we emerge from the pandemic.