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

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, C...

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Autores principales: 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
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Publicado: Dove Medical Press 2020
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spelling oai:doaj.org-article:fcb20240e51846c3ae34c7de938451522021-12-02T11:00:41ZManaging Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach1178-203Xhttps://doaj.org/article/fcb20240e51846c3ae34c7de938451522020-07-01T00:00:00Zhttps://www.dovepress.com/managing-disease-modifying-therapies-and-breakthrough-activity-in-mult-peer-reviewed-article-TCRMhttps://doaj.org/toc/1178-203XSherif 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, AustriaCorrespondence: Amr HassanKasr Al Ainy Faculty of Medicine, Cairo University, P.O.11553, Cairo, EgyptTel +201006060809Email amrhasanneuro@kasralainy.edu.egAbstract: 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 therapiesHamdy SMAbdel-Naseer MShehata HSHassan AElmazny AShalaby NMAbokrysha NTKishk NANada MAFAhmed SMHegazy MIMekkawy DMourad HSAbdelalim ABerger TDove Medical Pressarticlecovid-19multiple sclerosisdisease-modifying therapiesTherapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol Volume 16, Pp 651-662 (2020)
institution DOAJ
collection DOAJ
language EN
topic covid-19
multiple sclerosis
disease-modifying therapies
Therapeutics. Pharmacology
RM1-950
spellingShingle covid-19
multiple sclerosis
disease-modifying therapies
Therapeutics. Pharmacology
RM1-950
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
Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
description 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, AustriaCorrespondence: Amr HassanKasr Al Ainy Faculty of Medicine, Cairo University, P.O.11553, Cairo, EgyptTel +201006060809Email amrhasanneuro@kasralainy.edu.egAbstract: 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
format article
author 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
author_facet 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
author_sort Hamdy SM
title Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_short Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_full Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_fullStr Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_full_unstemmed Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_sort managing disease-modifying therapies and breakthrough activity in multiple sclerosis patients during the covid-19 pandemic: toward an optimized approach
publisher Dove Medical Press
publishDate 2020
url https://doaj.org/article/fcb20240e51846c3ae34c7de93845152
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