Disease-modifying therapies and SARS-CoV-2 vaccination in multiple sclerosis: an expert consensus

Diego Centonze,Hans-Peter Hartung,Celia Oreja-Guevara,Massimo Filippi,Claudio Gasperini,Heinz Wiendl,Maria A Rocca,Maria Trojano,Ludwig Kappos,Melinda Magyari

doi:10.1007/s00415-021-10545-2

Abstract

Coronavirus disease (COVID-19) appeared in December 2019 in the Chinese city of Wuhan and has quickly become a global pandemic. The disease is caused by the severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2), an RNA beta coronavirus phylogenetically similar to SARS coronavirus. To date, more than 132 million cases of COVID19 have been recorded in the world, of which over 2.8 million were fatal (https://coronavirus.jhu.edu/map.html). A huge vaccination campaign has started around the world since the end of 2020. The availability of vaccines has raised some concerns among neurologists regarding the safety and efficacy of vaccination in patients with multiple sclerosis (MS) taking immunomodulatory or immunosuppressive therapies.

Highlights

The clinical course of COVID-19 is characterized by three different phases
This leads to sepsis and disseminated intravasal coagulation which may manifest with both multiorgan failure and fatal outcome [1]
The main entry route of SARS-CoV-2 involves the interaction between the viral spike protein and the angiotensin-converting enzyme-related carboxypeptidase 2 (ACE2) expressed by the host cells [2]

Summary

Introduction

The clinical course of COVID-19 is characterized by three different phases. In the first phase of the disease, the patient is asymptomatic or has mild flu-like symptoms characterized by fatigue, high temperature and dry cough. Treatment with IFNs does not appear to increase the risk of infection or worsen the disease course [16, 17], while many studies demonstrate that these molecules reduce the risk of SARSCoV-2 infection in treated MS patients [12]. Current data from case series and retrospective studies show that severe disease course was observed in none of 79 patients treated with teriflunomide and infected with SARS-CoV-2 [17, 22,23,24].

Results

Conclusion