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Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach.
Arq Neuropsiquiatr. 2020 07; 78(7):430-439.AN

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.

Authors+Show Affiliations

School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32609290

Citation

ApÓstolos-Pereira, Samira Luisa, et al. "Management of Central Nervous System Demyelinating Diseases During the Coronavirus Disease 2019 Pandemic: a Practical Approach." Arquivos De Neuro-psiquiatria, vol. 78, no. 7, 2020, pp. 430-439.
ApÓstolos-Pereira SL, Silva GD, Disserol CCD, et al. Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach. Arq Neuropsiquiatr. 2020;78(7):430-439.
ApÓstolos-Pereira, S. L., Silva, G. D., Disserol, C. C. D., Feo, L. B., Matos, A. M. B., Schoeps, V. A., Gomes, A. B. A. G. R., Boaventura, M., Mendes, M. F., & Callegaro, D. (2020). Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach. Arquivos De Neuro-psiquiatria, 78(7), 430-439. https://doi.org/10.1590/0004-282x20200056
ApÓstolos-Pereira SL, et al. Management of Central Nervous System Demyelinating Diseases During the Coronavirus Disease 2019 Pandemic: a Practical Approach. Arq Neuropsiquiatr. 2020;78(7):430-439. PubMed PMID: 32609290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach. AU - ApÓstolos-Pereira,Samira Luisa, AU - Silva,Guilherme Diogo, AU - Disserol,Caio César Diniz, AU - Feo,Lucas Bueno, AU - Matos,Aline de Moura Brasil, AU - Schoeps,Vinicius Andreoli, AU - Gomes,Ana Beatriz Ayroza Galvão Ribeiro, AU - Boaventura,Mateus, AU - Mendes,Maria Fernanda, AU - Callegaro,Dagoberto, Y1 - 2020/07/01/ PY - 2020/05/23/received PY - 2020/05/31/accepted PY - 2020/7/2/pubmed PY - 2020/7/2/medline PY - 2020/7/2/entrez SP - 430 EP - 439 JF - Arquivos de neuro-psiquiatria JO - Arq Neuropsiquiatr VL - 78 IS - 7 N2 - 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. SN - 1678-4227 UR - https://www.unboundmedicine.com/medline/citation/32609290/Management_of_central_nervous_system_demyelinating_diseases_during_the_coronavirus_disease_2019_pandemic:_a_practical_approach L2 - https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020005015202&lng=en&nrm=iso&tlng=en DB - PRIME DP - Unbound Medicine ER -
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