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Review
. 2020 Jul 22:16:651-662.
doi: 10.2147/TCRM.S257714. eCollection 2020.

Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach

Sherif M Hamdy  1 , Maged Abdel-Naseer  1 , Hatem S Shehata  1 , Amr Hassan  1 , Alaa Elmazny  1 , Nevin M Shalaby  1 , Noha T Abokrysha  1 , Nirmeen A Kishk  1 , Mona A F Nada  1 , Sandra M Ahmed  1 , Mohamed I Hegazy  1 , Doaa Mekkawy  1 , Husam S Mourad  1 , Ahmed Abdelalim  1 , Thomas Berger  2
Affiliations
Review

Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach

Sherif M Hamdy et al. Ther Clin Risk Manag. .

Abstract

The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of COVID-19 and the lack of specific anti-virus therapies, the current management is essentially supportive. There is an absence of consensus on guidelines or treatment strategies for complex disorders such as multiple sclerosis (MS), in which the risk of infections is higher than in the general population. This is due to the overall impairment of the immune system typical of autoimmune diseases, in addition to accumulation of disabilities, and the iatrogenic effect generated by corticosteroids and the recommended disease-modifying therapies (DMTs). DMTs have different modes of action, but all modulate and interfere with the patient's immune response, thereby raising concerns about adverse effects, such as an increased susceptibility to infections. In this review, we analyze the evidence for use of DMTs during the current critical period and ratify an algorithmic approach for management to optimize care between keeping DMTs, with their infection hazards, or coming off them, with the risk of disease activation. We also provide an algorithmic approach to the management of breakthrough activity during the COVID-19 pandemic.

Keywords: COVID-19; disease-modifying therapies; multiple sclerosis.

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Conflict of interest statement

Thomas Berger has participated in the last 2 years in meetings sponsored by and received honoraria (lectures, advisory boards, consultations) from pharmaceutical companies marketing treatments for multiple sclerosis: Almirall, Biogen, Bionorica, Celgene, MedDay, Merck, Novartis, Roche, Sanofi Aventis/Genzyme, TG Therapeutics and TEVA.His institution has received financial support in the last 2 years by unrestricted research grants (Biogen, Novartis, Sanofi Aventis/Genzyme, Roche, TEVA) and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Biogen, Merck, Novartis, Roche, Sanofi Aventis/Genzyme, TEVA. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Algorithm of initiation and maintenance of DMTs in RRMS patients during COVID-19 pandemic. Abbreviations: COVID-19, coronavirus disease 2019; DMF, dimethyl fumarate; DMT, disease-modifying therapy; INF, interferon; JCV, John Cunningham virus; RRMS, relapsing–remitting multiple sclerosis.
Figure 2
Figure 2
Algorithm of relapse management in RRMS patients during COVID-19 pandemic. Abbreviations: COVID-19, coronavirus disease 2019; IVIG, intravenous immunoglobulins; IVMP, intravenous methylprednisolone; RRMS, relapsing–remitting multiple sclerosis.
See this image and copyright information in PMC

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