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Review
. 2020 Sep;16(9):493-505.
doi: 10.1038/s41582-020-0385-8. Epub 2020 Jul 8.

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

Catharina Korsukewitz  1 , Stephen W Reddel  2 , Amit Bar-Or  3 , Heinz Wiendl  4
Affiliations
Review

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

Catharina Korsukewitz et al. Nat Rev Neurol. 2020 Sep.

Erratum in

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is concerning for patients with neuroimmunological diseases who are receiving immunotherapy. Uncertainty remains about whether immunotherapies increase the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or increase the risk of severe disease and death upon infection. National and international societies have developed guidelines and statements, but consensus does not exist in several areas. In this Review, we attempt to clarify where consensus exists and where uncertainty remains to inform management approaches based on the first principles of neuroimmunology. We identified key questions that have been addressed in the literature and collated the recommendations to generate a consensus calculation in a Delphi-like approach to summarize the information. We summarize the international recommendations, discuss them in light of the first available data from patients with COVID-19 receiving immunotherapy and provide an overview of management approaches in the COVID-19 era. We stress the principles of medicine in general and neuroimmunology in particular because, although the risk of viral infection has become more relevant, most of the considerations apply to the general management of neurological immunotherapy. We also give special consideration to immunosuppressive treatment and cell-depleting therapies that might increase susceptibility to SARS-CoV-2 infection but reduce the risk of severe COVID-19.

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Conflict of interest statement

C.K. has received travel support and/or speaking honoraria from Biogen, Sanofi Genzyme, Roche, Merck and Teva within the past years. S.R. has received funds within the past 5 years for (but not limited to) travel support, honoraria, trial payments, research and clinical support to the neurology department of which he is a member from several bodies and charities such as Lambert Initiative, Beeren Foundation and anonymous donors, and from Baxter, Bayer Schering, Biogen Idec, CSL, Sanofi Genzyme, Grifols, Octapharma, Merck, Novartis, Roche, Sanofi Aventis Genzyme, Servier and Teva. S.R. also declares the following competing interests: co-founder and shareholder of Medical Safety Systems trading as RxMx (including grant and/or contracts with Genzyme, Novartis, Roche and Janssen); receives payment for contributions to the National IVIg Governance Advisory Council & Specialist Working Group Australia (Neurology) and the Australian Medical Services Advisory Committee ad hoc sub-committee on IVIg; unpaid member of the Australian Technical Advisory Group on Immunization Varicella Zoster working party; receives a public salary as a staff specialist neurologist from Concord Hospital Sydney Local Health District; receives private billings from patients and Medicare Australia reimbursement as a private practice neurologist; and is an unpaid medical adviser to various patient and advocacy groups. A.B.-O. serves on scientific advisory boards for Atara Biotherapeutics, Biogen Idec, Celgene/Receptos, Janssen/Actelion, Merck/EMD Serono, Novartis, Roche/Genentech and Sanofi Genzyme, and has sponsored research agreements with Biogen Idec, Novartis and Roche/Genentech. H.W. receives honoraria for acting as a member of scientific advisory boards for Biogen, Evgen, Genzyme, MedDay Pharmaceuticals, Merck Serono, Novartis, Roche Pharma AG and Sanofi-Aventis, as well as speaker honoraria and travel support from Alexion, Biogen, Cognomed, F. Hoffmann-La Roche, Gemeinnützige Hertie-Stiftung, Merck Serono, Novartis, Roche Pharma AG, Genzyme, Teva and WebMD Global. H.W. is also a paid consultant for Abbvie, Actelion, Biogen, IGES, Johnson & Johnson, Merck, Novartis, Roche and Sanofi. His research is funded by the German Ministry for Education and Research (BMBF), Deutsche Forschungsgemeinschaft (DFG), Else Kröner Fresenius Foundation, Fresenius Foundation, the European Union, Hertie Foundation, NRW Ministry of Education and Research, Interdisciplinary Center for Clinical Studies (IZKF) Muenster and RE Children’s Foundation, Biogen, GlaxoSmithKline GmbH, Roche Pharma AG and Sanofi Genzyme.

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