Global COVID-19 advice for people with MS
COVID-19 is a new illness that can affect your lungs and airways. It is caused by a novel coronavirus thatwas first detected in people in China in December 2019 and has since spread to other parts of the world.
There is currently no evidence on how COVID-19 affects people with multiple sclerosis (MS). The advice
below was developed by MS neurologists* and research experts from MSIF’s member organisations**.
This advice will be reviewed and updated as evidence about COVID-19 becomes available.

Advice for people with MS
People with underlying lung and heart conditions and those aged over 60 years are more likely toexperience complications and become severely ill with the COVID-19 virus. This group will include many
people living with MS, especially those with additional health complications, mobility issues and thosetaking some MS treatments.
All people with MS are advised to pay particular attention to guidelines for reducing the risk of infection
with COVID-19. Older people with MS, especially those who also have lung or heart diseases should takeextra care to minimise their exposure to the virus. The World Health Organization recommendations
include:Wash your hands frequently with soap and water or an alcohol-based hand rub

Avoid touching your eyes, nose and mouth unless your hands are clean

Try to keep at least 1 metre distance between yourself and others, particularly those who arecoughing and sneezingWhen coughing and sneezing, cover your mouth and nose with a flexed elbow or tissue

Practise food safety by using different chopping boards for raw meat and cooked foods and wash
your hands between handling them

In addition, we recommend that people with MS should:
Avoid public gatherings and crowds



Avoid using public transport where possible

Where possible, use alternatives to face-to-face routine medical appointments (for example,telephone appointments).

Caregivers and family members who live with, or regularly visit, a person with MS should also follow
these recommendations to reduce the chance of bringing COVID-19 infection into the home.

1Advice regarding disease-modifying therapies for MS
Many disease modifying therapies (DMTs) for MS work by suppressing or modifying the immune system.
Some MS medications might increase the likelihood of developing complications from a COVID-19
infection but this risk needs to be balanced with the risks of stopping treatment. We recommend that:

People with MS currently taking DMTs continue with their treatment.

People who develop symptoms of COVID-19 or test positive for the infection discuss their MS
therapies with their MS care provider or another health care professional who is familiar withtheir care.

Before starting on any new DMT, people with MS discuss with their healthcare professional
which therapy is the best choice for their individual disease course and disease activity in light of
COVID-19 risk in the region.

Those who are due to start on a DMT but have not yet done so, should consider selecting atreatment that does not reduce specific immune cells (lymphocytes). Examples include:interferons, glatiramer acetate, or natalizumab. Medications that reduce lymphocytes overlonger intervals include alemtuzumab, cladribine, ocrelizumab and rituximab.

The following oral DMTs may reduce the ability of the immune system to respond to an infection:
fingolimod, dimethyl fumarate, teriflunomide and siponimod. People should carefully consider
the risks and benefits of initiating these treatments during the COVID-19 pandemic.

People with MS who are currently taking alemtuzumab, cladribine, ocrelizumab, rituximab,fingolimod, dimethyl fumarate, teriflunomide or siponimod and are living in a community with aCOVID-19 outbreak should isolate as much as possible to reduce their risk of infection.

Recommendations on delaying second or further doses of alemtuzumab, cladribine, ocrelizumab andrituximab due to the COVID-19 outbreak differ between countries. People who take these medications
and are due for the next dose should consult their healthcare professional about the risks and benefitsof postponing treatment.
Advice regarding aHSCT
Autologous Haematopoietic Stem Cell Treatment (aHSCT) includes intensive chemotherapy treatment.
This severely weakens the immune system for a period of time. People who have recently undergone
treatment should extend the period they remain in isolation during the COVID-19 outbreak. People whoare due to undergo treatment should consider postponing the procedure in consultation with theirhealthcare professional.
Advice for children or pregnant women with MS
At this time there is no specific advice for women with MS who are pregnant. There is general
information on COVID-19 and pregnancy on the US Centre for Disease Control and Prevention website.
There is no specific advice for children with MS; they should follow the advice above for people with MS.
2

The following individuals were consulted in the development of this advice:*MS neurologists
Professor Brenda Banwell, Chair of MSIF’s International Medical and Scientific Advisory Board –University of Pennsylvania, USADr Fernando Hamuy Diaz de Bedoya, President of LACTRIMS – Universidad Nacional de Asuncion,
Paraguay
Professor Andrew Chan – Bern University Hospital, Switzerland
Professor Jeffrey Cohen, President of ACTRIMS – Cleveland Clinic Mellen Center for Multiple Sclerosis,
USA
Dr Jorge Correale, Deputy Chair of MSIF’s International Medical and Scientific Advisory Board – FLENI,
Argentina
Professor Giancarlo Comi – Università Vita Salute San Raffaele, Italy
Professor Kazuo Fujihara, President of PACTRIMS – Fukushima Medical University School of Medicine,Japan
Professor Bernhard Hemmer, President of ECTRIMS – Technische Universität München, Germany
Dr Céline Louapre – Sorbonne Université, France
Professor Catherine Lubetzki – ICM, France
Professor Marco Salvetti – Sapienza University, Italy
Dr Joost Smolders – ErasmusMC, Netherlands
Professor Per Soelberg Sørensen – University of Copenhagen, Denmark
Professor Bassem Yamout, President of MENACTRIMS – American University of Beirut Medical Center,
Lebanon**MSIF member organisations
Dr Clare Walton, Nick Rijke, Victoria Gilbert, Peer Baneke – MS International FederationPhillip Anderson – MS Society (UK)
Pedro Carrascal – Esclerosis Múltiple España (Spain)
Dr Tim Coetzee, Dr Doug Landsman, Julie Fiol – National MS Society (US)Professor Judith Haas – Deutsche Multiple Sklerose Gesellschaft Bundesverband e.V (Germany)
Dr Kirstin Heutinck – Stichting MS Research (Netherlands)
Dr Pam Kanellis – MS Society of Canada
Nora Kriauzaitė – European MS Platform
Dr Marc Lutz – La Société suisse de la sclérose en plaques (Switzerland)Marie Lynning – Scleroseforeningen (Denmark)Dr Julia Morahan – MS Research Australia
Dr Emmanuelle Plassart-Schiess – ARSEP Fondation (France)
Dr Paola Zaratin – Associazione Italiana Sclerosi Multipla Onlus (Italy)
This statement was agreed on 13th March 20203