Is natalizumab a safe treatment for patients with multiple sclerosis in the COVID-19 pandemic? Data from the first year of the pandemic

Abstract

BackgroundPatients with MS have increased risk of infections, especially those with highly active treatments. We studied the safety of natalizumab in patients with MS during the COVID-19 pandemic.MethodsDemographic features, time on natalizumab, dose interval and COVID-19 symptoms were evaluated in a prospective study of patients with MS receiving natalizumab during the pandemic. RT-PCR COVID-19 tests from nasopharyngeal samples were performed before natalizumab treatment.ResultsWe analyzed 69 patients: 71% women, mean age 43 years. Mean treatment duration was 68 months (range: 2–141). In 32% of patients, natalizumab regimen was changed from every 4 to every 6 weeks to decrease number of hospital visits. From March to April 2020, 5 patients had COVID-19, 4 showed mild symptoms and 1 a multi-lobar pneumonia. On May 2020, we started COVID-19 screening before natalizumab infusion. From May 2020 to March 2021, tests were performed on 553 nasopharyngeal swabs. Fourteen patients had a positive result and natalizumab was stopped; tests were repeated 1–2 weeks later, with negative results, and natalizumab was restarted. In summary: 19 patients had COVID-19, 10 asymptomatic, 7 mild symptoms, 2 pneumonia (1 of whom hospitalized without mechanical ventilation). There were no statistically significant differences in age (mean±standard deviation, 35.7±11.5 vs 43.4±7.8 years; p=0.158), dose interval (5.33 vs 5.32 weeks; p=0.962) or treatment duration (5.8 vs 5.6 years; p=0.298) between patients with and without COVID-19.ConclusionNatalizumab treatment in MS seems to be safe during the pandemic. Most patients were asymptomatic, and no patient required mechanical ventilation.