The current advice is to stop your DMT. However, this may be difficult in the current environment when not all people are being tested for COVID-19. My personal opinion is to only stop or suspend DMTs if you get severe infection and need to be admitted to hospital. If you get symptoms and are concerned about being on an immunosuppressive please contact your MS team.
Stopping natalizumab and any of the S1P modulators (fingolimod, siponimod, etc.) puts you at high-risk of rebound disease activity once the treatment effect of these therapies wears off. You can transition from these therapies onto immunomodulatory DMTs, which are not immunosuppressive, but this needs to be carefully planned and will probably not be feasible during the acute infection.
In my opinion, both natalizumab and fingolimod are relatively safe DMTs during the COVID-19 pandemic, i.e. if you do become infected you are likely to be able to mount an appropriate immune response to the virus. The reason why I say this is because pwMS on natalizumab or fingolimod seem to deal with viral infections reasonably well in the phase 3 trials and extension studies. In addition, patients on fingolimod or natalizumab who were infected with dengue fever virus recovered without sequelae (see dengue page).
It is important to remember that it takes at least 6-8 weeks for fingolimod's action on the immune system to be reversed. So stopping it will probably have little impact on acute symptomatic COVID-19. In addition, if you stop taking it for more than 11 days then you have to repeat the first-dose monitoring protocol, which involves being observed in a healthcare setting. The latter is unlikely to be feasible for several months. For this reason I would recommend either interrupting dosing for as short a time as possible (maximum 10 days) or to continue taking fingolimod.
It takes 3-4 months for natalizumab to wash-out. Therefore missing an infusion because of acute symptomatic COVID-19 makes sense, more to protect healthcare staff and other patients in the infusion unit, than to help you.
Please note that many national guidelines, such as the Italian and ABN guidelines, are recommending suspending dosing with alemtuzumab, ocrelizumab, rituximab and cladribine and delaying starting HSCT in the current context. I agree with HSCT and alemtuzumab, but think a more case-by-case assessment is required for cladribine and the anti-CD20 therapies (ocrelizumab, rituximab, ofatumumab and ublituximab). The reason for my position on this is that cladribine and anti-CD20 therapies leave the T-cell compartment of the immune system relatively intact and there has not been any severe viral infections in the clinical trial programmes. The main viral infection noted with cladribine and anti-CD20 therapies is herpes zoster or shingles and even then these case tend to mild or moderate.
I am not sure of any reason why you can't continue to take interferon-beta., glatiramer acetate, teriflunomide and DMF during a COVID-19 infection. We don't advise stopping these treatments during a influenza or other viral infections so to be consistent I would suggest continuing these DMTs.
Date & Disclaimer: 19-March-2020; please note this information will be time limited and will change as new data emerges.