Disease-Modifying Therapies During the COVID-19 Outbreak

Abstract

Background: Managing multiple sclerosis (MS) during the novel coronavirus (COVID-19) pandemic is a challenge due to the lack of evidence from clinical studies. Disease-modifying therapies (DMTs) may affect the immune response and subsequently alter the risk of COVID-19 infections. Methods: A literature search was conducted on MEDLINE, Embase, and Cochrane databases. A focused Google search was also performed. The recommendations regarding the use of DMTs during the COVID-19 outbreak from national or international MS/neurology societies were identified and reviewed. Results: The review included 16 recommendations from international and national MS organizations. All recommendations are based on expert opinions. The recommendations regarding DMT initiation and management during this outbreak were summarized. Moreover, the experts' views about the risk of COVID-19 infection with each DMT were discussed as well. Conclusions: There is significant agreement among most experts' recommendations from a variety of sources based on collective clinical experience. However, the recommendations will likely evolve as sufficient clinical data are limited. Several ongoing registries will help to provide the information for future recommendations.

COVID-19 in ocrelizumab-treated people with multiple sclerosis

“…For patients with MS, it is currently debated whether they are at an increased risk of contracting SARS-CoV-2 infection ( Ghajarzadeh & Bonavita, 2020 ) or of developing a more severe course of COVID-19 compared with the general population and whether the different disease-modifying therapies (DMTs) play a specific role ( Amor et al, 2020 ; Giovannoni, 2020 ; Giovannoni et al, 2020 ). Multiple expert recommendations on the use of DMTs in MS have been published in the context of the COVID-19 pandemic ( Brownlee et al, 2020 ; Thakolwiboon et al, 2020 ). However, given the limited data available, neurologists are still faced with important challenges in the management of people with MS in the era of COVID-19, and high-quality evidence is needed to better understand the effect of COVID-19 in people with MS ( Peeters et al, 2020 ).…”

COVID-19 in teriflunomide-treated patients with multiple sclerosis: A case report and literature review

“…The specific mechanisms of action of the various DMTs and patients’ clinical characteristics should be taken into account to stratify the COVID-19-related risks in PwMS, although reassuring data from literature have highlighted that DMTs do not seem to increase the risk of acquiring COVID-19 ( Thakolwiboon et al., 2020 ). Indeed, the specific effect of DMT on immune response could be beneficial for blunting the consequences of the more severe forms of SARS-CoV-2 infection ( Ciotti et al., 2020 ).…”

Potential Risks and Benefits of Multiple Sclerosis Immune Therapies in the COVID-19 Era: Clinical and Immunological Perspectives

“…In terms of the risk of MS therapies during this pandemic from least to most favorable, the following ranking should be considered: alemtuzumab–cladribine–ocrelizumab/rituximab–fingolimod–and then all others [ 39 ] (see Table 1 ). Thakolwiboon et al [ 40 ] summarize recommendations by European neurological associations based on risk and mechanism of action. In individuals with active COVID-19, it is advised to defer therapy until symptoms abate [ 40 ].…”