Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism’s normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.

Multiple Sclerosis Patient Management During the COVID-19 Pandemic: Practical Recommendations From the Portuguese Multiple Sclerosis Study Group (GEEM)

“…From the beginning of the pandemic, tele-medicine has emerged in several countries as a possible solution for balancing the need to prevent infection with the need to keep an appropriate follow-up (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Tele-medicine enables the regular and close contact between patient and physician while lowering the need for patient's physical presence in Health Units, and hence the risk of exposure to SARS-CoV-2 (14,20).…”

“…In the last year, many publications addressed the care of MS under a global pandemic, describing cases of success (16,17,19), giving practical recommendations (11)(12)(13)(14), and sometimes focusing on particular aspects of the teleconsultation (15). However, clear, systematic, consensus-based recommendations that reflect the opinion of diverse group of practitioners and can be widely adopted are largely missing, with two notable exceptions coming from Latin America (18,20) and Italy (21). Moreover, while attention has been paid to the content of the tele-consultation (18,20,21), there is a gap regarding the entire tele-consultation organization and management.…”

“…However, clear, systematic, consensus-based recommendations that reflect the opinion of diverse group of practitioners and can be widely adopted are largely missing, with two notable exceptions coming from Latin America (18,20) and Italy (21). Moreover, while attention has been paid to the content of the tele-consultation (18,20,21), there is a gap regarding the entire tele-consultation organization and management. Recognizing this gap, the Portuguese Multiple Sclerosis Study Group has developed a document with recommendations for using tele-consultation/telemedicine to manage MS patients.…”

Teleworking: the challenge of work in the post-pandemic world

“…A SARS-Cov-2, ou por outra, Síndrome Respiratória Aguda Grave coronavírus 2, que manifesta nas pessoas a doença clínica denominada Covid-19, teve seus primeiros casos diagnosticados na província de Wuhan, uma cidade chinesa com população urbana de 8,896,900 de habitantes e que possui um mercado de venda de animais e outros subprodutos, recebedor de visitantes de diversas partes do país em busca de novos negócios o que pode ter contribuído com a proliferação rápida para outras províncias, principalmente as que recebem com regularidade estrangeiros representantes de empresas de diferentes arenas comerciais do mundo (APÓSTOLOS-PEREIRA et al, 2020;SAFADI, 2020).…”

Vaccination Setting of Patients with Autoimmune Diseases in Times of Severe Acute Respiratory Syndrome Coronavirus Type 2 Pandemic Using the Example of Multiple Sclerosis Patients: A Longitudinal Multicenter Study

“…This is far from the target flu jab coverage of 75% of EU residents. Particularly older and more disabled patients with MS appeared to be at increased risk for severe acute respiratory syndrome coronavirus type 2 (SARS CoV-2) infection with more complicated disease courses [17][18][19][20][21][22][23][24][25].…”