Disease-modifying therapies for multiple sclerosis

Angelis, Floriana De; John, Nevin; Brownlee, Wallace

doi:10.1136/bmj.k4674

Cited by 77 publications

(71 citation statements)

References 48 publications

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“…An acute infection will sometimes lead to a transient worsening of symptoms in MS and other disorders (pseudo-relapse). 9 Patients should be carefully screened for symptoms of active COVID-19 infection before receiving corticosteroid treatment.…”

Section: Managing Patients With Ms Without Covid-19 Infectionmentioning

confidence: 99%

“…A few MS therapies (interferon-β and glatiramer acetate) exert immunomodulatory effects with no increase in the risk of systemic infections. Other treatments used in contemporary MS practice do have immunosuppressive effects with alterations in lymphocyte number, trafficking, proliferation, and function, 9 with an increased risk of infections, including viral infections and respiratory infections. 7,9 It is reasonable to hypothesize that these therapies may predispose to a greater risk of COVID-19 infection and potentially more severe infection.…”

Section: Disease-modifying Therapiesmentioning

confidence: 99%

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Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic

et al. 2020

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The emergence of novel coronavirus 2019 (COVID-19) 1 and the subsequent pandemic present a unique challenge to neurologists managing patients with multiple sclerosis (MS) and related neuroinflammatory disorders, such as neuromyelitis spectrum disorder (NMOSD). National professional bodies (e.g., Italian Society of Neurology and Association of British Neurologists) and patient organizations (e.g., National MS Society, MS International Federation, UK MS Society, and MS Australia) have responded rapidly by issuing guidelines for the COVID-19 pandemic, primarily focused on MS disease-modifying therapies (DMTs). In this commentary, we highlight the implications of COVID-19 for people with MS and related disorders, including the risk of respiratory infections, general health advice, and recommendations (from consensus-based guidelines) for immunotherapies, relapse management, and service delivery during the COVID-19 pandemic. Risk of respiratory infectionsWhether people with MS and NMOSD are at an increased risk of COVID-19 infection or at a higher risk of more severe infection is unknown. There are no data available on whether the rate of mild, self-limiting respiratory infections that do not require a medical encounter is increased in people with MS. However, there is increased infection-related health care utilization across all age groups in people with MS compared with the general population. 2 These infections include pneumonia 2,3 (particularly in people with bulbar weakness resulting in aspiration and impaired pulmonary function due to severe quadriparesis) and influenza, 3 but not upper respiratory tract infections. 2 Older age, male sex, worse physical disability, and lower socioeconomic status are associated with increased hospitalization rates in MS. 3 People with MS have a higher risk of intensive care unit admission with infections and higher 1-year mortality after admission than the general population. 4 In addition to the higher background risk of infection-related health care utilization, people with MS treated with the secondgeneration DMTs are exposed to a further increased risk of infections. 5 These factors should be considered when counseling individuals about the risks of COVID-19 infection. General health advicePeople with MS and related disorders should follow World Health Organization (WHO) and national or local health authority guidance on preventive measures to reduce transmission of COVID-19 in the general population. These include social distancing, frequent hand washing with soap and water or an alcohol-based hand rub, and respiratory hygiene. Advice from the WHO is updated regularly (who.int/emergencies/diseases/novel-coronavirus-2019).

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Section: Managing Patients With Ms Without Covid-19 Infectionmentioning

confidence: 99%

Section: Disease-modifying Therapiesmentioning

confidence: 99%

Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic

et al. 2020

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“…Multiple sclerosis is an immune-mediated, chronic, demyelinating disorder, which is commonly considered to result from the interaction of environmental and genetic factors that still unclear [26,100]. It's the most common neurological disease among young adults and meanwhile a major cause of physical disability among young adults [26,85]. Current MS phenotypic classifications contain RRMS, CIS, PPMS and SPMS, which means relapsing-remitting multiple sclerosis, clinically isolated syndrome, primary-progressive multiple sclerosis, and secondary-progressive multiple sclerosis respectively [71].…”

Section: Introductionmentioning

confidence: 99%

The role of chemokines and chemokine receptors in multiple sclerosis

Cui

Chu

Chen

2020

International Immunopharmacology

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Multiple sclerosis (MS) is a chronic inflammatory disease that is characterized by leukocyte infiltration and subsequent axonal damage, demyelinating inflammation, and formation of sclerosing plaques in brain tissue. The results of various studies in patients indicate that autoimmunity and inflammation make an important impact on the pathogenesis of MS. Chemokines are key mediators of inflammation development and cell migration, mediating various immune cell responses, including chemotaxis and immune activation, and are important in immunity and inflammation, therefore we focus on chemokines and their receptors in multiple sclerosis. In this article, we summarize the study of the role of prominent chemokines and their receptors in MS patients and MS animal modelsand discuss their potential significance in inflammatory injury and repair of MS. We have also summarized the progress in the treatment of multiple sclerosis antagonists in recent years with chemokine receptors as targets.

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“…The use of DMT is not uniformly regulated and guidelines for MS treatment can differ between countries. In the following, the drugs which are most commonly used in Europe are listed in alphabetical order: alemtuzumab, a monoclonal anti-CD52 antibody [159]; cladribine, which depletes both B and T cells; dimethyl fumarate, which is proposed to inhibit nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling and to alter immune cell activation; fingolimod, a sphingosin-1-phosphate receptor (S1PR) agonist which inhibits immune cell emigration from secondary lymphoid organs [160]; glatiramer acetate [161] and interferon-β [162], two immune modulatory drugs; natalizumab, a potent α 4 -integrin inhibitor which prevents lymphocyte migration over the BBB [160]; mitoxantrone, a cytostatic agent [163]; ocrelizumab, a monoclonal anti-CD20 antibody which depletes B cells; and teriflunomide, which has anti-proliferative action on immune cells [160].…”

Section: Treatment Of Msmentioning

confidence: 99%

Strategies for Neuroprotection in Multiple Sclerosis and the Role of Calcium

Enders

Heider

Ludwig

et al. 2020

IJMS

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Calcium ions are vital for maintaining the physiological and biochemical processes inside cells. The central nervous system (CNS) is particularly dependent on calcium homeostasis and its dysregulation has been associated with several neurodegenerative disorders including Parkinson's disease (PD), Alzheimer's disease (AD) and Huntington's disease (HD), as well as with multiple sclerosis (MS). Hence, the modulation of calcium influx into the cells and the targeting of calcium-mediated signaling pathways may present a promising therapeutic approach for these diseases. This review provides an overview on calcium channels in neurons and glial cells. Special emphasis is put on MS, a chronic autoimmune disease of the CNS. While the initial relapsing-remitting stage of MS can be treated effectively with immune modulatory and immunosuppressive drugs, the subsequent progressive stage has remained largely untreatable. Here we summarize several approaches that have been and are currently being tested for their neuroprotective capacities in MS and we discuss which role calcium could play in this regard.

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Disease-modifying therapies for multiple sclerosis

Cited by 77 publications

References 48 publications

Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic

Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic

The role of chemokines and chemokine receptors in multiple sclerosis

Strategies for Neuroprotection in Multiple Sclerosis and the Role of Calcium

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