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Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach

The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of C...

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Autores principales: Hamdy, Sherif M, Abdel-Naseer, Maged, Shehata, Hatem S, Hassan, Amr, Elmazny, Alaa, Shalaby, Nevin M, Abokrysha, Noha T, Kishk, Nirmeen A, Nada, Mona A F, Ahmed, Sandra M, Hegazy, Mohamed I, Mekkawy, Doaa, Mourad, Husam S, Abdelalim, Ahmed, Berger, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398889/
https://www.ncbi.nlm.nih.gov/pubmed/32801722
http://dx.doi.org/10.2147/TCRM.S257714
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author Hamdy, Sherif M
Abdel-Naseer, Maged
Shehata, Hatem S
Hassan, Amr
Elmazny, Alaa
Shalaby, Nevin M
Abokrysha, Noha T
Kishk, Nirmeen A
Nada, Mona A F
Ahmed, Sandra M
Hegazy, Mohamed I
Mekkawy, Doaa
Mourad, Husam S
Abdelalim, Ahmed
Berger, Thomas
author_facet Hamdy, Sherif M
Abdel-Naseer, Maged
Shehata, Hatem S
Hassan, Amr
Elmazny, Alaa
Shalaby, Nevin M
Abokrysha, Noha T
Kishk, Nirmeen A
Nada, Mona A F
Ahmed, Sandra M
Hegazy, Mohamed I
Mekkawy, Doaa
Mourad, Husam S
Abdelalim, Ahmed
Berger, Thomas
author_sort Hamdy, Sherif M
collection PubMed
description The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of COVID-19 and the lack of specific anti-virus therapies, the current management is essentially supportive. There is an absence of consensus on guidelines or treatment strategies for complex disorders such as multiple sclerosis (MS), in which the risk of infections is higher than in the general population. This is due to the overall impairment of the immune system typical of autoimmune diseases, in addition to accumulation of disabilities, and the iatrogenic effect generated by corticosteroids and the recommended disease-modifying therapies (DMTs). DMTs have different modes of action, but all modulate and interfere with the patient’s immune response, thereby raising concerns about adverse effects, such as an increased susceptibility to infections. In this review, we analyze the evidence for use of DMTs during the current critical period and ratify an algorithmic approach for management to optimize care between keeping DMTs, with their infection hazards, or coming off them, with the risk of disease activation. We also provide an algorithmic approach to the management of breakthrough activity during the COVID-19 pandemic.
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spelling pubmed-73988892020-08-14 Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach Hamdy, Sherif M Abdel-Naseer, Maged Shehata, Hatem S Hassan, Amr Elmazny, Alaa Shalaby, Nevin M Abokrysha, Noha T Kishk, Nirmeen A Nada, Mona A F Ahmed, Sandra M Hegazy, Mohamed I Mekkawy, Doaa Mourad, Husam S Abdelalim, Ahmed Berger, Thomas Ther Clin Risk Manag Review The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of COVID-19 and the lack of specific anti-virus therapies, the current management is essentially supportive. There is an absence of consensus on guidelines or treatment strategies for complex disorders such as multiple sclerosis (MS), in which the risk of infections is higher than in the general population. This is due to the overall impairment of the immune system typical of autoimmune diseases, in addition to accumulation of disabilities, and the iatrogenic effect generated by corticosteroids and the recommended disease-modifying therapies (DMTs). DMTs have different modes of action, but all modulate and interfere with the patient’s immune response, thereby raising concerns about adverse effects, such as an increased susceptibility to infections. In this review, we analyze the evidence for use of DMTs during the current critical period and ratify an algorithmic approach for management to optimize care between keeping DMTs, with their infection hazards, or coming off them, with the risk of disease activation. We also provide an algorithmic approach to the management of breakthrough activity during the COVID-19 pandemic. Dove 2020-07-22 /pmc/articles/PMC7398889/ /pubmed/32801722 http://dx.doi.org/10.2147/TCRM.S257714 Text en © 2020 Hamdy et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Review
Hamdy, Sherif M
Abdel-Naseer, Maged
Shehata, Hatem S
Hassan, Amr
Elmazny, Alaa
Shalaby, Nevin M
Abokrysha, Noha T
Kishk, Nirmeen A
Nada, Mona A F
Ahmed, Sandra M
Hegazy, Mohamed I
Mekkawy, Doaa
Mourad, Husam S
Abdelalim, Ahmed
Berger, Thomas
Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_full Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_fullStr Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_full_unstemmed Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_short Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach
title_sort managing disease-modifying therapies and breakthrough activity in multiple sclerosis patients during the covid-19 pandemic: toward an optimized approach
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398889/
https://www.ncbi.nlm.nih.gov/pubmed/32801722
http://dx.doi.org/10.2147/TCRM.S257714
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