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

Authors Hamdy SM, Abdel-Naseer M, Shehata HS, Hassan A, Elmazny A, Shalaby NM, Abokrysha NT, Kishk NA, Nada MAF, Ahmed SM, Hegazy MI, Mekkawy D, Mourad HS, Abdelalim A, Berger T

Received 17 April 2020

Accepted for publication 21 June 2020

Published 22 July 2020 Volume 2020:16 Pages 651—662


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Professor Garry Walsh

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 AF Nada,1 Sandra M Ahmed,1 Mohamed I Hegazy,1 Doaa Mekkawy,1 Husam S Mourad,1 Ahmed Abdelalim,1 Thomas Berger2

1Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Neurology Department, Medical University of Vienna, Vienna, Austria

Correspondence: Amr Hassan
Kasr Al Ainy Faculty of Medicine, Cairo University, P.O.11553, Cairo, Egypt
Tel +201006060809

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, multiple sclerosis, disease-modifying therapies

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