Case series: Teriflunomide therapy in COVID-19 patients with MS

June 12, 2020

During the COVID-19 pandemic, patients with multiple sclerosis (MS) and their clinicians have had questions and concerns about whether immunotherapies for MS could influence risk for infection or lead to an unfavorable outcome.

In the Journal of Neurology, Rohit Bakshi, MD, a senior neurologist at Brigham and Women's Hospital, and international co-authors present the cases of five MS patients who developed COVID-19 infection while taking the oral disease-modifying therapy teriflunomide and continued taking the medication. All five patients had favorable outcomes, with their COVID-19 taking a mild course and without experiencing relapse of their MS.

"Managing MS during the COVID-19 pandemic has raised many questions," said Bakshi, the corresponding author of the paper. "Our observations in these five patients suggest that teriflunomide may not need to be discontinued in patients with MS who develop an active COVID-19 infection. We also discuss potential direct anti-viral effects of teriflunomide."

Investigating Teriflunomide's Role in COVID-19 Outcomes

In the current international, multicenter study, Bakshi and co-authors, including lead author Amir Hadi Maghzi, MD, a clinical and research fellow in the Brigham's Neurology Department, report on five patients, ranging in age from 52 to 79, who had been taking teriflunomide for at least six months. The patients continued their teriflunomide therapy after COVID-19 diagnosis and had self-limiting illness without experiencing MS relapse.

Treatment for MS usually requires long-term therapy, often with immunomodulating or immunosuppressing drugs. Teriflunomide modulates the immune response by selectively reducing the level of activated T and B lymphocytes without suppressing the body's full immune response. One possibility, the authors write, is that teriflunomide could prevent an excessive immune response while maintaining an adequate defense against the virus. The authors also discuss pre-clinical data suggesting that the drug may reducing reduce viral nucleotide synthesis in infected cells.

The case series was small, retrospective, open-label, uncontrolled, and non-randomized, and the authors state that future studies are necessary to understand what role, if any, teriflunomide therapy may play in COVID-19 infection since patient recovery may be unrelated to the treatment.

"A delicate balance may be necessary in the host immune response to successfully confront COVID-19 infection," said Bakshi. "Additional studies are warranted to further understand the relationship between treatment with teriflunomide and outcomes for MS patients with COVID-19."
-end-
Disclosures: Maghzi is supported by a clinician-scientist development fellowship from the National Multiple Sclerosis Society and American Brain Foundation. Bakshi has received consulting fees from Bayer, Biogen, BMS/Celgene, EMD Serono, Genentech, and Novartis, and research support from BMS/Celgene, EMD Serono, and Sanofi-Genzyme. A full list of disclosures is available in the paper.

Brigham and Women's Hospital

Related Multiple Sclerosis Articles from Brightsurf:

New therapy improves treatment for multiple sclerosis
A new therapy that binds a cytokine to a blood protein shows potential in treating multiple sclerosis, and may even prevent it.

'Reelin' in a new treatment for multiple sclerosis
In an animal model of multiple sclerosis (MS), decreasing the amount of a protein made in the liver significantly protected against development of the disease's characteristic symptoms and promoted recovery in symptomatic animals, UTSW scientists report.

Not all multiple sclerosis-like diseases are alike
Scientists say some myelin-damaging disorders have a distinctive pathology that groups them into a unique disease entity.

New therapeutic options for multiple sclerosis in sight
Strategies for treating multiple sclerosis have so far focused primarily on T and B cells.

Diet has an impact on the multiple sclerosis disease course
The short-chain fatty acid propionic acid influences the intestine-mediated immune regulation in people with multiple sclerosis (MS).

The gut may be involved in the development of multiple sclerosis
It is incompletely understood which factors in patients with multiple sclerosis act as a trigger for the immune system to attack the brain and spinal cord.

Slowing the progression of multiple sclerosis
Over 77,000 Canadians are living with multiple sclerosis, a disease whose causes still remain unknown.

7T MRI offers new insights into multiple sclerosis
Investigators from Brigham and Women's Hospital have completed a new study using 7 Tesla (7T) MRI -- a far more powerful imaging technology -- to further examine LME in MS patients

How to improve multiple sclerosis therapy
Medications currently used to treat multiple sclerosis (MS) can merely reduce relapses during the initial relapsing-remitting phase.

Vaccinations not a risk factor for multiple sclerosis
Data from over 12,000 multiple sclerosis (MS) patients formed the basis of a study by the Technical University of Munich (TUM) which investigated the population's vaccination behavior in relation to MS.

Read More: Multiple Sclerosis News and Multiple Sclerosis Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.