Treatment of multiple sclerosis during COVID-19 pandemic

Multiple sclerosis patients are by definition more susceptible to infections,which dependents on the use of disease-modifying treatments. Depending on the mechanismof 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 drugswith different mechanisms of action on the immune system, the impact of therapy onsusceptibility 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 beenassigned recommendations: 1) low-risk therapies (glatiramer acetate, interferons,dimethyl fumarate, teriflunomide) – discontinuation of therapy and delay of treatmentinitiation is not recommended; 2) moderate-risk therapies (fingolimod, natalizumab,ocrelizumab, cladribine) – require caution, individual risk/benefit assessment, riskanalysis of multiple sclerosis symptom exacerbation after drug discontinuation; 3)high-risk therapies (alemtuzumab, mitoxantrone, haematopoietic stem cellstransplantation) – treatment initiation is not recommended, administration of subsequentdoses requires extreme caution. The article reviews the recommendations and publicationsfrom the last 2 years, taking into account the changing views on the treatment ofmultiple sclerosis in the time of COVID-19 pandemic.