Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERS
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic keeps the world in suspense. In addition to the fundamental challenges for the health care system, the individual departments must decide how to deal with patients at risk. Neurologists are confronted with the question, how they s...
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| Format: | Article |
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Frontiers Media S.A.
2020-05-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fimmu.2020.01059/full |
| _version_ | 1819168607587794944 |
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| author | Nora Möhn Refik Pul Christoph Kleinschnitz Harald Prüss Harald Prüss Torsten Witte Martin Stangel Thomas Skripuletz |
| author_facet | Nora Möhn Refik Pul Christoph Kleinschnitz Harald Prüss Harald Prüss Torsten Witte Martin Stangel Thomas Skripuletz |
| author_sort | Nora Möhn |
| collection | DOAJ |
| description | Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic keeps the world in suspense. In addition to the fundamental challenges for the health care system, the individual departments must decide how to deal with patients at risk. Neurologists are confronted with the question, how they should advise their patients regarding immunosuppressive treatment. In particular, the large number of different disease-modifying therapies (DMTs) in the treatment of neuroimmunological diseases such as multiple sclerosis poses a challenge. To a limited extent, it might be useful to transfer knowledge from previous SARS- and Middle East respiratory syndrome (MERS) coronavirus outbreaks in 2002/2003 and 2012 to the current situation. Overall, immunosuppressive therapy does neither seem to have a major impact on infection with SARS- and MERS-CoV nor does it seem to lead to a severe disease course in many cases. Considering the immunological responses against infections with novel coronaviruses in humans, interferons, glatiramer acetate, and teriflunomide appear to be safe. As lymphopenia seems to be associated with a more severe disease course, all DMTs causing lymphopenia, such as cladribine, alemtuzumab, and dimethyl fumarate, need to be reviewed more thoroughly. As they are, in general, associated with a higher risk of infection, depleting anti-CD20 antibodies may be problematic drugs. However, it has to be differentiated between the depletion phase and the phase of immune reconstitution. In summary, previous coronavirus outbreaks have not shown an increased risk for immunocompromised patients. Patients with severe neuroimmunological diseases should be kept from hasty discontinuation of immunotherapy. |
| first_indexed | 2024-12-22T19:06:18Z |
| format | Article |
| id | doaj.art-2bdb9428fefd482d9971f35c4e0e13df |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-22T19:06:18Z |
| publishDate | 2020-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-2bdb9428fefd482d9971f35c4e0e13df2022-12-21T18:15:49ZengFrontiers Media S.A.Frontiers in Immunology1664-32242020-05-011110.3389/fimmu.2020.01059549175Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERSNora Möhn0Refik Pul1Christoph Kleinschnitz2Harald Prüss3Harald Prüss4Torsten Witte5Martin Stangel6Thomas Skripuletz7Department of Neurology, Hanover Medical School, Hanover, GermanyDepartment of Neurology, University Hospital Essen, Essen, GermanyDepartment of Neurology, University Hospital Essen, Essen, GermanyDepartment of Neurology, Charité Universitätsmedizin Berlin, Berlin, GermanyGerman Center for Neurodegenerative Diseases (DZNE), Berlin, GermanyDepartment of Rheumatology and Immunology, Hannover Medical School, Hanover, GermanyDepartment of Neurology, Hanover Medical School, Hanover, GermanyDepartment of Neurology, Hanover Medical School, Hanover, GermanySevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic keeps the world in suspense. In addition to the fundamental challenges for the health care system, the individual departments must decide how to deal with patients at risk. Neurologists are confronted with the question, how they should advise their patients regarding immunosuppressive treatment. In particular, the large number of different disease-modifying therapies (DMTs) in the treatment of neuroimmunological diseases such as multiple sclerosis poses a challenge. To a limited extent, it might be useful to transfer knowledge from previous SARS- and Middle East respiratory syndrome (MERS) coronavirus outbreaks in 2002/2003 and 2012 to the current situation. Overall, immunosuppressive therapy does neither seem to have a major impact on infection with SARS- and MERS-CoV nor does it seem to lead to a severe disease course in many cases. Considering the immunological responses against infections with novel coronaviruses in humans, interferons, glatiramer acetate, and teriflunomide appear to be safe. As lymphopenia seems to be associated with a more severe disease course, all DMTs causing lymphopenia, such as cladribine, alemtuzumab, and dimethyl fumarate, need to be reviewed more thoroughly. As they are, in general, associated with a higher risk of infection, depleting anti-CD20 antibodies may be problematic drugs. However, it has to be differentiated between the depletion phase and the phase of immune reconstitution. In summary, previous coronavirus outbreaks have not shown an increased risk for immunocompromised patients. Patients with severe neuroimmunological diseases should be kept from hasty discontinuation of immunotherapy.https://www.frontiersin.org/article/10.3389/fimmu.2020.01059/fullSARSMERSCOVID-19multiple sclerosisimmunosuppressive therapyDMTs |
| spellingShingle | Nora Möhn Refik Pul Christoph Kleinschnitz Harald Prüss Harald Prüss Torsten Witte Martin Stangel Thomas Skripuletz Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERS Frontiers in Immunology SARS MERS COVID-19 multiple sclerosis immunosuppressive therapy DMTs |
| title | Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERS |
| title_full | Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERS |
| title_fullStr | Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERS |
| title_full_unstemmed | Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERS |
| title_short | Implications of COVID-19 Outbreak on Immune Therapies in Multiple Sclerosis Patients—Lessons Learned From SARS and MERS |
| title_sort | implications of covid 19 outbreak on immune therapies in multiple sclerosis patients lessons learned from sars and mers |
| topic | SARS MERS COVID-19 multiple sclerosis immunosuppressive therapy DMTs |
| url | https://www.frontiersin.org/article/10.3389/fimmu.2020.01059/full |
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