Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Arquivos de neuro-psiquiatria (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020000700430 |
Resumo: | 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. |
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Arquivos de neuro-psiquiatria (Online) |
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Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approachMultiple SclerosisNeuromyelitis Optica Spectrum DisordersCoronavirusImmunosuppressive AgentsDrug Side EffectsABSTRACT 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.Academia Brasileira de Neurologia - ABNEURO2020-07-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020000700430Arquivos de Neuro-Psiquiatria v.78 n.7 2020reponame:Arquivos de neuro-psiquiatria (Online)instname:Academia Brasileira de Neurologiainstacron:ABNEURO10.1590/0004-282x20200056info:eu-repo/semantics/openAccessAPÓSTOLOS-PEREIRA,Samira LuisaSILVA,Guilherme DiogoDISSEROL,Caio César DinizFEO,Lucas BuenoMATOS,Aline de Moura BrasilSCHOEPS,Vinicius AndreoliGOMES,Ana Beatriz Ayroza Galvão RibeiroBOAVENTURA,MateusMENDES,Maria FernandaCALLEGARO,Dagobertoeng2020-07-29T00:00:00Zoai:scielo:S0004-282X2020000700430Revistahttp://www.scielo.br/anphttps://old.scielo.br/oai/scielo-oai.php||revista.arquivos@abneuro.org1678-42270004-282Xopendoar:2020-07-29T00:00Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologiafalse |
dc.title.none.fl_str_mv |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach |
title |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach |
spellingShingle |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach APÓSTOLOS-PEREIRA,Samira Luisa Multiple Sclerosis Neuromyelitis Optica Spectrum Disorders Coronavirus Immunosuppressive Agents Drug Side Effects |
title_short |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach |
title_full |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach |
title_fullStr |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach |
title_full_unstemmed |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach |
title_sort |
Management of central nervous system demyelinating diseases during the coronavirus disease 2019 pandemic: a practical approach |
author |
APÓSTOLOS-PEREIRA,Samira Luisa |
author_facet |
APÓSTOLOS-PEREIRA,Samira Luisa SILVA,Guilherme Diogo DISSEROL,Caio César Diniz FEO,Lucas Bueno MATOS,Aline de Moura Brasil SCHOEPS,Vinicius Andreoli GOMES,Ana Beatriz Ayroza Galvão Ribeiro BOAVENTURA,Mateus MENDES,Maria Fernanda CALLEGARO,Dagoberto |
author_role |
author |
author2 |
SILVA,Guilherme Diogo DISSEROL,Caio César Diniz FEO,Lucas Bueno MATOS,Aline de Moura Brasil SCHOEPS,Vinicius Andreoli GOMES,Ana Beatriz Ayroza Galvão Ribeiro BOAVENTURA,Mateus MENDES,Maria Fernanda CALLEGARO,Dagoberto |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
APÓSTOLOS-PEREIRA,Samira Luisa SILVA,Guilherme Diogo DISSEROL,Caio César Diniz FEO,Lucas Bueno MATOS,Aline de Moura Brasil SCHOEPS,Vinicius Andreoli GOMES,Ana Beatriz Ayroza Galvão Ribeiro BOAVENTURA,Mateus MENDES,Maria Fernanda CALLEGARO,Dagoberto |
dc.subject.por.fl_str_mv |
Multiple Sclerosis Neuromyelitis Optica Spectrum Disorders Coronavirus Immunosuppressive Agents Drug Side Effects |
topic |
Multiple Sclerosis Neuromyelitis Optica Spectrum Disorders Coronavirus Immunosuppressive Agents Drug Side Effects |
description |
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. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-07-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020000700430 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020000700430 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/0004-282x20200056 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Academia Brasileira de Neurologia - ABNEURO |
publisher.none.fl_str_mv |
Academia Brasileira de Neurologia - ABNEURO |
dc.source.none.fl_str_mv |
Arquivos de Neuro-Psiquiatria v.78 n.7 2020 reponame:Arquivos de neuro-psiquiatria (Online) instname:Academia Brasileira de Neurologia instacron:ABNEURO |
instname_str |
Academia Brasileira de Neurologia |
instacron_str |
ABNEURO |
institution |
ABNEURO |
reponame_str |
Arquivos de neuro-psiquiatria (Online) |
collection |
Arquivos de neuro-psiquiatria (Online) |
repository.name.fl_str_mv |
Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologia |
repository.mail.fl_str_mv |
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