SARS-CoV-2 Infection and Risk Management in Multiple Sclerosis

Abstract

The novel coronavirus can cause a severe respiratory disease with impact on the central nervous system, as has been reported by several medical health services. In the COVID-19 pandemic caused by the SARS-CoV-2 neurotrophic virus, neurologists have focused their attention on the early identification of suggestive manifestations of the neurological impact of the disease. In this context, they are exploring related chronic disease and the possibility of achieving a more effective understanding of symptoms derived from COVID-19 infection and those derived from the course of preexisting neurological disease. The present review summarizes evidence from the infection with SARS-CoV-2 and the management of the risks of multiple sclerosis and how it is related to the risks of general comorbidities associated with COVID-19. In addition, we reviewed other factors characteristic of MS, such as relapses, and the maximum tolerated dose of treatment medications from clinical and experimental evidence.

Characteristics and management of multiple sclerosis patients during the Omicron era: is there a concern about the MS course in the face of the new variant of COVID-19?

“…We revealed SPMS as the main contributor to developing COVID-19, and other demographic and MS characteristics, including DMT type, did not increase the risk of developing COVID-19. It should be noted that, in this line, previous pre-Omicron outbreak meta-analyses did not exhibit whether a specific DMT significantly modifies the progression of SARS-CoV-2 in the MS population [ 12 , 13 ].…”

Comorbidities, Associated Diseases, and Risk Assessment in COVID-19—A Systematic Review

“…Treatment with glatiramer acetate, interferon-beta, and teriflunomide has a reduced predisposition to viral infections because they have a reduced risk of immunosuppression. Teriflunomide and interferon alpha have the property of inhibiting viral replication and having an antiviral effect [ 198 ].…”

“…Lymphopenia may be due to dimethyl fumarate, especially in early treatment, which increases the potential threat of COVID-19 in lymphopenic individuals [ 198 ]. Natalizumab is a highly effective drug deemed with minimal risk of acquiring or exhibiting severe forms of SARS-CoV-2 because it does not interact with lymphocytes.…”

“…Natalizumab is a highly effective drug deemed with minimal risk of acquiring or exhibiting severe forms of SARS-CoV-2 because it does not interact with lymphocytes. Fingolimod, siponimod, ozanimod (Sphingosine 1-phosphate receptor modulator), ocrelizumab, and rituximab (anti-CD-20 modulators) are drugs with a reduced immunosuppressive effect and a reduced predisposition to infection with the novel coronavirus [ 198 ].…”

“…The most effective options for the therapeutic management of MS present the highest predisposition to infection due to their action on lymphocytes, being labeled as the most predisposing treatment for this viral infection, affecting immunity, resulting in recurrences or low defense mechanisms against infections [ 198 ]. Concerning therapy in individuals with both mild MS and infection with the novel coronavirus, first-line treatment (glatiramer, interferons, dimethyl fumarate, teriflunomide) is preferred.…”