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.

Keywords: COVID-19; SARS-CoV-2; benefit versus risk in multiple sclerosis (BRMS); multiple sclerosis (MS).

Figure 1

Proposed flowchart to follow in the management of patients with MS outbreak–remission (BRMS) and the risk of COVID-19. Legend: BRMS: benefit versus risk for MS, DMT: disease-modifying therapies, first-line DMT*: interferons, glatirameracetate, dimethyl fumarate (DMF), and teriflunomide, second-line DMT**: natalizumab, fingolimod, AlemtmAb: alemtuzumab, cladribine, Ocre-mAb: ocrelizumab, rituximab, MP: methylprednisolone, PE: plasma exchange, JCV: John Cunningham virus.