Joseph R Berger1, Rachel Brandstadter2, Amit Bar-Or2. 1. From the Division of Multiple Sclerosis, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. joseph.berger@pennmedicine.upenn.edu. 2. From the Division of Multiple Sclerosis, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Abstract
OBJECTIVE: To address concerns regarding the effect of MS disease-modifying therapies (DMTs) on the expression of coronavirus 2019 (COVID-19). METHODS: Review of the current state of knowledge regarding the viral etiology of COVID-19, mechanisms of injury by SARS-CoV-2 infection, and the effect of individual DMTs on the risk of infection and COVID-19 disease expression. RESULTS: Although data are limited, MS DMTs do not obviously increase the risk of acquiring symptomatic SARS-CoV-2 infection. The severe morbidity and mortality of SARS-CoV-2 appear to be largely the consequence of an overly robust immune response rather than the consequence of unchecked viral replication. The effects of specific MS DMTs on the immune response that may increase the risk of impaired viral clearance and their potential counterbalancing beneficial effects on the development of COVID-19-associated acute respiratory distress syndrome are reviewed. CONCLUSION: Although there is currently insufficient real-world experience to definitively answer the question of the effect of a specific MS DMT on COVID-19, registries presently in nascent form should provide these answers. This review provides an approach to addressing these concerns while the data are being accumulated. Early insights suggest that the risk of infection and associated morbidity of COVID-19 in this population is little different than that of the population at large.
OBJECTIVE: To address concerns regarding the effect of MS disease-modifying therapies (DMTs) on the expression of coronavirus 2019 (COVID-19). METHODS: Review of the current state of knowledge regarding the viral etiology of COVID-19, mechanisms of injury by SARS-CoV-2 infection, and the effect of individual DMTs on the risk of infection and COVID-19 disease expression. RESULTS: Although data are limited, MS DMTs do not obviously increase the risk of acquiring symptomatic SARS-CoV-2 infection. The severe morbidity and mortality of SARS-CoV-2 appear to be largely the consequence of an overly robust immune response rather than the consequence of unchecked viral replication. The effects of specific MS DMTs on the immune response that may increase the risk of impaired viral clearance and their potential counterbalancing beneficial effects on the development of COVID-19-associated acute respiratory distress syndrome are reviewed. CONCLUSION: Although there is currently insufficient real-world experience to definitively answer the question of the effect of a specific MS DMT on COVID-19, registries presently in nascent form should provide these answers. This review provides an approach to addressing these concerns while the data are being accumulated. Early insights suggest that the risk of infection and associated morbidity of COVID-19 in this population is little different than that of the population at large.
Authors: Mitchell T Wallin; William J Culpepper; Jonathan D Campbell; Lorene M Nelson; Annette Langer-Gould; Ruth Ann Marrie; Gary R Cutter; Wendy E Kaye; Laurie Wagner; Helen Tremlett; Stephen L Buka; Piyameth Dilokthornsakul; Barbara Topol; Lie H Chen; Nicholas G LaRocca Journal: Neurology Date: 2019-02-15 Impact factor: 9.910
Authors: Stanley L Cohan; Barry A Hendin; Anthony T Reder; Kyle Smoot; Robin Avila; Jason P Mendoza; Bianca Weinstock-Guttman Journal: CNS Drugs Date: 2021-07-06 Impact factor: 5.749