Open Access<p>Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach</p>
Author(s) -
Sherif Hamdy,
Maged Abdel Naseer,
Hatem S. Shehata,
Amr Hassan,
Alaa Elmazny,
Nevin Shalaby,
Noha T. Abokrysha,
Nirmeen A. Kishk,
Moda,
Sandra Ahmed,
Mohamed I. Hegazy,
Doaa Mekkawy,
Husam S Mourad,
Ahmed Abdelalim,
Thomas Berger
Publication year - 2020
Publication title -
therapeutics and clinical risk management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.719
H-Index - 55
eISSN - 1178-203X
pISSN - 1176-6336
DOI - 10.2147/tcrm.s257714
Subject(s) - medicine , pandemic , intensive care medicine , disease , multiple sclerosis , adverse effect , covid-19 , novelty , disease management , public health , population , fingolimod , immunology , environmental health , infectious disease (medical specialty) , philosophy , theology , nursing , parkinson's disease
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.