SARS‐CoV‐2 and Multiple Sclerosis: Not All Immune Depleting DMTs are Equal or Bad

Neurological immunotherapy in the era of COVID-19 — looking for consensus in the literature

“…Five patients were classified as critically ill and needed intensive care. Among the limited data currently available, outcomes of COVID-19 during B cell-depleting therapy range from mild disease to death but -although the number of patients is low -rates of critical illness and death do not seem to be increased dramatically relative to the wider population 93 . This observation could be explained by the fact that, although B cell-depleting therapies are thought to increase susceptibility to acute respiratory infections 94 , antibody-mediated inflammation and a cytokine storm are thought to mediate severe COVID-19 outcomes, so B cell depletion might not necessarily be associated with more severe disease 95 .…”

“…In addition, upregulation of cytokines can lead to a cytokine storm 127 . In this second phase of severe COVID-19, some immunotherapies might have the potential to attenuate or even prevent critical illness 93,128 , although this potential is largely theoretical at present and there is a long history of similar hypotheses that have rarely come to fruition.…”

Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients

“…While enlightening the general lack of evidence about the risks of IST in milder forms of COVID-19, they recommended that clinicians should consider interrupting treatment in case of comorbidities or worsening of symptoms. However, there are contradictory opinions on this issue, since other authors suggest that the moderate immunosuppression induced by MS treatments may protect from developing more severe forms of COVID-19 [46]. In addition to this, authors expressed their doubts about the short-term usage of high-dose corticosteroids in MS relapses during the pandemic, since it does not influence the final degree of recovery and could be associated with a higher risk of viral reactivation [47]; therefore, they advised to keep a high threshold on the administration of such treatment.…”

COVID-19 and Multiple Sclerosis: Predisposition and Precautions in Treatment

“…The concerns for patients with MS are because of an increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and more severe disease due to taking disease-modifying therapies that have immunosuppressive effects in MS patients [47,48] and also the fact that viral infections may contribute to MS exacerbation and relapses as an environmental factor in genetically predisposed individuals [38,39].…”