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Table 1 Disease-modifying therapies (DMTs) recommendations for patients with Multiple Sclerosis (PwMS) during COVID-19 pandemic 

From: A comprehensive review of COVID-19 symptoms and treatments in the setting of autoimmune diseases

Type of DMT

The mechanism of action

Indication of DMT initiation and maintenance during COVID-19 pandemic

References

Interferon-Beta (INF-β)

T-cell proliferation and leukocyte migration across the blood-brain barrier (BBB) are inhibited by the down-regulation of MHC expression on the APCs and the suppression of pro-inflammatory cytokines

Can be implemented.

If influenza-like symptoms reoccur, it should be discontinued until a definite diagnosis can be made

[45, 89]

Glatiramer Acetate

Transforms inflammatory T-helper-1 cells into regulatory

T-helper-2 cells

Can be implemented.

Systemic risk of infection is not increased when using this medication

[45, 89]

Teriflunomide

Inhibition of cytostatic effects by reversible and selective targeting of T and B cells

Can be implemented.

Should be discontinued in COVID-19 confirmed cases

[45]

Dimethyl Furmarate (DMF)

Reduction of pro-inflammatory cytokines and lymphocyte entry into the CNS

Can be implemented.

Should be discontinued in COVID-19 confirmed cases

[45]

Fingolimid

Isolation of lymphocytes in secondary lymphoid tissues

Not indicated.

It is associated to an increased risk of infection

[45, 90]

Natalizumab (NTZ)

Compromising immune supervision only in the CNS by preventing the active lymphocyte trafficking through the blood-brain barrier

It can be initiated and maintained if patients are not infected by COVID-19.

Should be discontinued in COVID-19 confirmed patients

[45]

Cladribine

Optional reduction of CD19 + B lymphocytes and T lymphocytes

Not indicated

[45, 91, 92]

Rituximab

Cellular cytolysis of CD20-expressing B lymphocytes via a selective connection to these cells, and activating complement mediated cell lysis

Not indicated

[45, 91, 92]

Ocrelizumab

Cellular cytolysis of CD20-expressing B lymphocytes via selectively connecting to these cells, and the activation of complement mediated cell lysis

Not indicated

[45]

Alemtuzumab (AMZ)

Induction of T and B cell depletion through antibody-dependent cellular cytotoxicity

Not indicated

[45]

  1. APC antigen presenting cell, MHC major histocompatibility complex