Multiple Sclerosis Treatment in the COVID-19 Era: A Risk-Benefit Approach

Abstract

The COVID-19 pandemic poses an ongoing global challenge, and several risk factors make people with multiple sclerosis (pwMS) particularly susceptible to running a severe disease course. Although the literature does report numerous articles on the risk factors for severe COVID-19 and vaccination response in pwMS, there is a scarcity of reviews integrating both these aspects into strategies aimed at minimizing risks. The aim of this review is to describe the risk of vulnerable pwMS exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the issues related to the SARS-CoV-2 vaccine and to evidence possible future strategies in the clinical management of pwMS. The authors searched for papers on severe COVID-19 risk factors, SARS-CoV-2 vaccination and people with multiple sclerosis in support of this narrative literature review. We propose a multilevel strategy aimed at: the evaluation of risk factors for severe COVID-19 in people with multiple sclerosis, identifying the most appropriate vaccination schedule that is safe for people on disease-modifying drugs (DMDs) and a strict follow-up of high-risk people with multiple sclerosis to allow for the prompt administration of monoclonal antibodies to manage COVID-19 risks in this patient population.

Characteristics and management of multiple sclerosis patients during the Omicron era: is there a concern about the MS course in the face of the new variant of COVID-19?

“…A recent review highlighted the older age, male gender, EDSS score of > 3, cardiac comorbidities, obesity, progressive MS course, and recent administration of high doses of corticosteroid as the significant risk factors for developing severe COVID-19 [ 14 ]. Likewise, an Iranian multicenter study recommended recent pulse steroid therapy and probably anti-CD20 monoclonal antibodies as substantial contributors to severe COVID-19 [ 8 ].…”

Summary of Safety and Efficacy of COVID Vaccination in Patients with Multiple Sclerosis

“…Multiple sclerosis (MS) is a chronic inflammatory degenerative disease of the central nervous system (CNS) characterized by early axonal damage that causes the most common nontraumatic disability in young adults worldwide. Global prevalence in 2020 reached almost 36 per 100,000 persons, and an estimated 2.8 million people are living with this condition around the world [1][2][3][4] (Fig. 1; Table 1).…”

The Role of Cytotoxic T-Lymphocyte Antigen 4 in the Pathogenesis of Multiple Sclerosis

“…At the beginning of the COVID-19 pandemic, there were many reserves concerning the treatment of MS patients with disease-modifying drugs owing to the risk of severe COVID-19, and many neurologists were hesitant to start therapy or change it because of the fear of COVID-19 infection [ 29 ]. Nevertheless, delaying treatment or switching one type of drug with another one with a stronger efficacy could cause MS undertreatment and the accrual of disability [ 29 ].…”

“…At the beginning of the COVID-19 pandemic, there were many reserves concerning the treatment of MS patients with disease-modifying drugs owing to the risk of severe COVID-19, and many neurologists were hesitant to start therapy or change it because of the fear of COVID-19 infection [ 29 ]. Nevertheless, delaying treatment or switching one type of drug with another one with a stronger efficacy could cause MS undertreatment and the accrual of disability [ 29 ]. Therefore, an individual evaluation of the risk of a severe COVID-19 infection should be performed for MS patients by defining the most appropriate vaccination schedule, considering the treatment with the disease-modifying drugs, and comparing the possible risks in avoiding this treatment with its benefits [ 29 ].…”

“…Nevertheless, delaying treatment or switching one type of drug with another one with a stronger efficacy could cause MS undertreatment and the accrual of disability [ 29 ]. Therefore, an individual evaluation of the risk of a severe COVID-19 infection should be performed for MS patients by defining the most appropriate vaccination schedule, considering the treatment with the disease-modifying drugs, and comparing the possible risks in avoiding this treatment with its benefits [ 29 ].…”