Managing multiple sclerosis (MS) during the coronavirus disease 2019 (COVID-19) pandemic presents multiple challenges, but treatment with the oral disease-modifying therapy teriflunomide shows favorable outcomes among 5 patients whose cases were presented in the Journal of Neurology.1

“Our observations in these 5 patients suggest that teriflunomide may not need to be discontinued in patients with MS who develop an active COVID-19 infection,” said corresponding author Rohit Bakshi, MD, in a statement.2

Teriflunomide is an immunomodulating drug commonly used to treat MS, which often requires long-term therapy. The drug modulates the immune response by selectively reducing the level of activated T and B lymphocytes without suppressing the full immune response.1

The ongoing international, multicenter study is examining 5 patients ranging in age from 52 to 79 years, all of whom have been taking teriflunomide for at least 5 months.1 All of the patients continued taking teriflunomide after their COVID-19 diagnosis and had self-limiting illness without experiencing a relapse of their MS.1

The authors posited that teriflunomide could prevent an excessive immune response while still maintaining enough defense against the virus. They also noted that patients with MS who were treated with teriflunomide generally also developed effective immunity to seasonal influenza and rabies after the vaccinations, which could be an important thing to note when looking to the future of a COVID-19 vaccine.1

The investigators did note that their case series was small, retrospective, open-label, uncontrolled, and non-randomized, so more studies are necessary in order to confirm and extend their preliminary findings.1

“A delicate balance may be necessary in the host immune response to successfully confront COVID-19 infection,” Bakshi said. “Additional studies are warranted to further understand the relationship between treatment with teriflunomide and outcomes for MS patients with COVID-19.”2

REFERENCES
  1. Maghzi A, Houtchens M, Preziosa P, et al. COVID-19 in teriflunomide-treated patients with multiple sclerosis. Journal of Neurology; June 3, 2020. https://link.springer.com/article/10.1007%2Fs00415-020-09944-8. Accessed June 18, 2020.
  2. Case series: Teriflunomide therapy in COVID-19 patients with MS [news release]. Brigham and Women’s Hospital; June 1, 2020. https://www.brighamandwomens.org/about-bwh/newsroom/research-briefs-detail?id=3595. Accessed June 18, 2020.