PwMS on natalizumab are asking whether they should stop or postpone their natalizumab infusions. The reason is to avoid social contacts and hence being infected with COVID-19.
I would say no.
The reason for this is that most patients on natalizumab have rapidly-evolving severe MS and are at high risk of rebound if their natalizumab is washed out. It is a great pity that the natalizumab home-infusion service was closed down. This would be an opportune time to resurrect it so that patients can be infused at home. In the future the subcutaneous formulation may also emerge as a treatment option, but this innovation is about 2 years off launch.
At our centre we are converting all of our patients on natalizumab, who have been on treatment for longer than 6 months, to EID or extended interval dosing (6-weekly infusions). The early data suggests that with EID there is no loss of efficacy and a reduced risk of PML infection that may extend to other neurotropic viruses.
I want to reassure our patients on natalizumab that COVID-19 is not at present a hospital-acquired infection, although this may change with time. If you follow personal hygiene rules you are unlikely to become infected by attending hospital for your infusions.
The other thing to remember is that this pandemic may last many months so a short-term delay in infusions is not really a solution. If you are really concerned about attending your MS centre for your infusions and want to avoid this I would suggest discussing switching to another DMT with your MS team. The latter may still require attendance at a healthcare facility to have baseline bloods performed.
I want to reassure pwMS that COVID-19 is a big issue at a population level, but if you do get infected the majority of pwMS will have a mild self-limiting infection.
At our hospital we will be moving our infusion service from the main hospital to clean site, which has no acute medical wards or A&E. The purpose of this move is minimise the risk of COVID-19 exposure as much as possible. We estimate that this will reduce your risk of hospital acquired exposure to little more than the background risk for all of us.
Date & Disclaimer: 18-March-2020; please note the information and advice in this case study may change with time.