Treatment of multiple sclerosis during COVID-19 pandemic

Abstract

Multiple sclerosis patients are by definition more susceptible to infections, which dependents on the use of disease-modifying treatments. Depending on the mechanism of action, individual disease-modifying treatments carry different risks. As a result, patients require an individualised approach to initiating and continuing new treatments. This problem became very important during the COVID-19 pandemic. In the case of drugs with different mechanisms of action on the immune system, the impact of therapy on susceptibility to SARS-CoV-2 infections and the course of COVID-19 should be considered. Based on the risk/ benefit analysis for the patient, individual therapies have been assigned recommendations: 1) low-risk therapies (glatiramer acetate, interferons, dimethyl fumarate, teriflunomide) – discontinuation of therapy and delay of treatment initiation is not recommended; 2) moderate-risk therapies (fingolimod, natalizumab, ocrelizumab, cladribine) – require caution, individual risk/benefit assessment, risk analysis of multiple sclerosis symptom exacerbation after drug discontinuation; 3) high-risk therapies (alemtuzumab, mitoxantrone, haematopoietic stem cells transplantation) – treatment initiation is not recommended, administration of subsequent doses requires extreme caution. The article reviews the recommendations and publications from the last 2 years, taking into account the changing views on the treatment of multiple sclerosis in the time of COVID-19 pandemic.