In this consensus statement, we provide updated recommendations on multiple sclerosis (MS) management during the COVID-19 crisis and the post-pandemic period applicable to neurology services around the world. Statements/recommendations were generated based on available literature and the experience of 13 MS expert panelists using a modified Delphi approach online. The statements/recommendations give advice regarding implementation of telemedicine; use of disease-modifying therapies and management of MS relapses; management of people with MS at highest risk from COVID-19; management of radiological monitoring; use of remote pharmacovigilance; impact on MS research; implications for lowest income settings, and other key issues.

Blizard Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK; Department of Neurology Royal London Hospital Barts Health NHS Trust London UK

Blizard Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK; Fundación Santa Fe de Bogotá Bogotá Colombia; School of Medicine Universidad de los Andes Bogotá Colombia

CORe Department of Medicine University of Melbourne Melbourne Australia; Melbourne MS Centre Department of Neurology Royal Melbourne Hospital Melbourne Australia

Department of Clinical Neurosciences Turku University Hospital and University of Turku Turku Finland

Department of Neurology and Center for Clinical Neuroscience General University Hospital and 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Neurology Graduate School of Medical Sciences Kyushu University Fukuoka Japan

Department of Neurology Massachusetts General Hospital Boston MA USA; Harvard Medical School Boston MA USA

Department of Neurology Neurosciences Center King Fahd Specialist Hospital Dammam Dammam Saudi Arabia

Department of Neuroscience Central Clinical School Monash University Melbourne Australia

Department of Pharmacy Royal London Hospital Barts Health NHS Trust London UK

Division of Neurology St Michael's Hospital University of Toronto Toronto ON Canada; Department of Neurology Johns Hopkins University Baltimore MD USA

Oxford University Hospitals NHS Foundation Trust Oxford UK

The Westmead Institute University of Sydney Sydney Australia

Zobrazit více v PubMed

Achiron A., Dolev M., Menascu S., Zohar D.-N., Dreyer-Alster S., Miron S., Shirbint E., Magalashvili D., Flechter S., Givon U., Guber D., Stern Y., Polliack M., Falb R., Gurevich M. COVID-19 vaccination in patients with multiple sclerosis: what we have learnt by February 2021. Mult. Scler. J. 2021;27(6):864–870. doi: 10.1177/13524585211003476. PubMed DOI PMC

Achiron A., Mandel M., Dreyer-Alster S., Harari G., Magalashvili D., Sonis P., Dolev M., Menascu S., Flechter S., Falb R., Gurevich M. Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies. Ther. Adv. Neurol. Disord. 2021;14:1–8. doi: 10.1177/17562864211012835. PubMed DOI PMC

Allotey J., Stallings E., Bonet M., Yap M., Chatterjee S., Kew T., Debenham L., Llavall A.C., Dixit A., Zhou D., Balaji R., Lee S.I., Qiu X., Yuan M., Coomar D., Van Wely M., Van Leeuwen E., Kostova E., Kunst H., Khalil A., Tiberi S., Brizuela V., Broutet N., Kara E., Kim C.R., Thorson A., Oladapo O.T., Mofenson L., Zamora J., Thangaratinam S. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320. doi: 10.1136/bmj.m3320. PubMed DOI PMC

Alonso R., Silva B., Garcea O., Diaz P.E.C., dos Passos G.R., Navarro D.A.R., Valle L.A.G., Salinas L.C.R., Negrotto L., Luetic G., Tkachuk V.A., Míguez J., de Bedoya F.H.D., Goiry L.G., Sánchez N.E.R., Burgos M., Steinberg J., Balbuena M.E., Alvarez P.M., López P.A., Ysrraelit M.C., León R.A., Cohen A.B., Gracia F., Molina O., Casas M., Deri N.H., Pappolla A., Patrucco L., Cristiano E., Tavolini D., Nadur D., Granda A.M.T., Weiser R., Cassará F.P., Sinay V., Rodríguez C.C., Lazaro L.G., Menichini M.L., Piedrabuena R., Escobar G.O., Carrá A., Chertcoff A., Pujols B.S., Vrech C., Tarulla A., Carvajal R., Mainella C., Becker J., Peeters L.M., Walton C., Serena M.A., Nuñez S., Rojas J.I. COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America: COVID-19 in MS and NMOSD patients in LATAM. Mult. Scler. Relat. Disord. 2021;51:102886. doi: 10.1016/j.msard.2021.102886. PubMed DOI PMC

Association of British Neurologists COVID-19 Response. 2020. https://www.theabn.org/page/covid19_response (accessed 8.23.20)

Australian Health Practitioner Regulation Agency Telehealth Guidance for Practitioners. 2020. https://www.ahpra.gov.au/News/COVID-19/Workforce-resources/Telehealth-guidance-for-practitioners.aspx (accessed 8.21.20)

Badal Sujan, Thapa Bajgain K., Badal Sujeena, Thapa R., Bajgain B.B., Santana M.J. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis. J. Clin. Virol. 2021;135:104715. doi: 10.1016/j.jcv.2020.104715. PubMed DOI PMC

Baker David, Amor S., Kang A.S., Schmierer K., Giovannoni G. The underpinning biology relating to multiple sclerosis disease modifying treatments during the COVID-19 pandemic. Mult. Scler. Relat. Disord. 2020;43:102174. doi: 10.1016/j.msard.2020.102174. PubMed DOI PMC

Baker D., Roberts C.A.K., Pryce G., Kang A.S., Marta M., Reyes S., Schmierer K., Giovannoni G., Amor S. COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases. Clin. Exp. Immunol. 2020;202(2):149–161. doi: 10.1111/cei.13495. PubMed DOI PMC

Bar-Or A., Calkwood J.C., Chognot C., Evershed J., Fox E.J., Herman A., Manfrini M., McNamara J., Robertson D.S., Stokmaier D., Wendt J.K., Winthrop K.L., Traboulsee A. Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis: the VELOCE study. Neurology. 2020;6(95) doi: 10.1212/WNL.0000000000010380. (14):e1999-e2008. PubMed DOI PMC

Barzegar M., Mirmosayyeb O., Ghajarzadeh M., Nehzat N., Vaheb S., Shaygannejad V., Vosoughi R. Characteristics of COVID-19 disease in multiple sclerosis patients. Mult. Scler. Relat. Disord. 2020;45:102276. doi: 10.1016/j.msard.2020.102276. PubMed DOI PMC

Berger J.R., Brandstadter R., Bar-Or A. COVID-19 and MS disease-modifying therapies. Neurol. Neuroimmunol. Neuroinflamm. 2020;7(4) doi: 10.1212/NXI.0000000000000761. e761. PubMed DOI PMC

Berlin D.A., Gulick R.M., Martinez F.J. Severe Covid-19. N. Engl. J. Med. 2020;383(25):2451–2460. doi: 10.1056/nejmcp2009575. PubMed DOI

Bermel R.A., You X., Foulds P., Hyde R., Simon J.H., Fisher E., Rudick R.A. Predictors of long-term outcome in multiple sclerosis patients treated with interferon beta. Ann. Neurol. 2013;73:95–103. doi: 10.1002/ana.23758. PubMed DOI

Bilger A., Plowshay J., Ma S., Nawandar D., Barlow E.A., Romero-Masters J.C., Bristol J.A., Li Z., Tsai M.H., Delecluse H.J., Kenney S.C. Leflunomide/teriflunomide inhibit Epstein-barr virus (EBV)-induced lymphoproliferative disease and lytic viral replication. Oncotarget. 2017;8:44266–44280. doi: 10.18632/oncotarget.17863. PubMed DOI PMC

Bowen J.D., Brink J., Brown T.R., Lucassen E.B., Smoot K., Wundes A., Repovic P. COVID-19 in MS: initial observations from the Pacific Northwest. Neurol. Neuroimmunol. Neuroinflamm. 2020;7:783. doi: 10.1212/NXI.0000000000000783. PubMed DOI PMC

Brownlee W., Bourdette D., Broadley S., Killestein J., Ciccarelli O. Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic. Neurology. 2020;94:949–952. doi: 10.1212/WNL.0000000000009507. PubMed DOI

Bsteh G., Bitschnau C., Hegen H., Auer M., Di Pauli F., Rommer P., Deisenhammer F., Berger T. Multiple sclerosis and COVID-19: how many are at risk? Eur. J. Neurol. 2020 doi: 10.1111/ene.14555. PubMed DOI PMC

Buljevac D., Flach H.Z., Hop W.C.J., Hijdra D., Laman J.D., Savelkoul H.F.J., van Der Meché F.G.A., van Doorn P.A., Hintzen R.Q. Prospective study on the relationship between infections and multiple sclerosis exacerbations. Brain. 2002;125:952–960. doi: 10.1093/brain/awf098. PubMed DOI

Cao B., Wang Y., Wen D., Liu W., Wang Jingli, Fan G., Ruan L., Song B., Cai Y., Wei M., Li X., Xia J., Chen N., Xiang J., Yu T., Bai T., Xie X., Zhang L., Li C., Yuan Y., Chen H., Li Huadong, Huang H., Tu S., Gong F., Liu Y., Wei Y., Dong C., Zhou F., Gu X., Xu J., Liu Z., Zhang Y., Li Hui, Shang L., Wang K., Li K., Zhou X., Dong X., Qu Z., Lu S., Hu X., Ruan S., Luo S., Wu J., Peng L., Cheng F., Pan L., Zou J., Jia C., Wang Juan, Liu X., Wang S., Wu X., Ge Q., He J., Zhan H., Qiu F., Guo L., Huang C., Jaki T., Hayden F.G., Horby P.W., Zhang D., Wang C. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N. Engl. J. Med. 2020;382:1787–1799. doi: 10.1056/NEJMoa2001282. PubMed DOI PMC

Chataway J., Porter B., Riazi A., Heaney D., Watt H., Hobart J., Thompson A. Home versus outpatient administration of intravenous steroids for multiple-sclerosis relapses: a randomised controlled trial. Lancet Neurol. 2006;5:565–571. doi: 10.1016/S1474-4422(06)70450-1. PubMed DOI

Chaudhry F., Bulka H., Rathnam A.S., Said O.M., Lin J., Lorigan H., Bernitsas E., Rube J., Korzeniewski S.J., Memon A.B., Levy P.D., Schultz L., Javed A., Lisak R., Cerghet M. COVID-19 in multiple sclerosis patients and risk factors for severe infection. J. Neurol. Sci. 2020;15(418):117147. doi: 10.1016/j.jns.2020.117147. PubMed DOI PMC

Ciampi E., Uribe-San-Martin R., Cárcamo C. COVID-19 pandemic: the experience of a multiple sclerosis Centre in Chile. Mult. Scler. Relat. Disord. 2020;42:102204. doi: 10.1016/j.msard.2020.102204. PubMed DOI PMC

Cordonnier C., Einarsdottir S., Cesaro S., Di Blasi R., Mikulska M., Rieger C., de Lavallade H., Gallo G., Lehrnbecher T., Engelhard D., Ljungman P., European Conference on Infections in Leukaemia group Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European conference on infections in leukaemia (ECIL 7) Lancet Infect. Dis. 2019;19(6):e200–e212. doi: 10.1016/S1473-3099(18)30600-5. PubMed DOI

Correale J., Fiol M., Gilmore W. The risk of relapses in multiple sclerosis during systemic infections. Neurology. 2006;67:652–659. doi: 10.1212/01.wnl.0000233834.09743.3b. PubMed DOI

De Angelis M., Petracca M., Lanzillo R., Brescia Morra V., Moccia M. Mild or no COVID-19 symptoms in cladribine-treated multiple sclerosis: two cases and implications for clinical practice. Mult. Scler. Relat. Disord. 2020;45:102452. doi: 10.1016/j.msard.2020.102452. PubMed DOI PMC

El-Lababidi R.M., Mooty M., Bonilla M.F., Salem N.M. Treatment of severe pneumonia due to COVID-19 with peginterferon alfa 2a. IDCases. 2020;21 doi: 10.1016/j.idcr.2020.e00837. PubMed DOI PMC

Epstein D.J., Dunn J., Deresinski S. Infectious complications of multiple sclerosis therapies: implications for screening, prophylaxis, and management. Open Forum Infect. Dis. 2018;5 doi: 10.1093/ofid/ofy174. ofy174. PubMed DOI PMC

Fan M., Qiu W., Bu B., Xu Y., Yang H., Huang D., Lau A.Y., Guo J., Zhang M.N., Zhang X., Yang C.S., Chen J., Zheng P., Liu Q., Zhang C., Shi F.D. Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders. Neurol. Neuroimmunol. Neuroinflamm. 2020;7(5) doi: 10.1212/NXI.0000000000000787. PubMed DOI PMC

Farez M.F., Correale J. Yellow fever vaccination and increased relapse rate in travelers with multiple sclerosis. Arch. Neurol. 2011;68(10):1267–1271. doi: 10.1001/archneurol.2011.131. PubMed DOI

Figueiro-Filho E.A., Yudin M., Farine D. COVID-19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries. J. Perinat. Med. 2020;48(9):900–911. doi: 10.1515/jpm-2020-0364. PubMed DOI

Förger F., Villiger P.M. Immunological adaptations in pregnancy that modulate rheumatoid arthritis disease activity. Nat. Rev. Rheumatol. 2020;16:113–122. doi: 10.1038/s41584-019-0351-2. PubMed DOI

Gianfrancesco M., Hyrich K.L., Hyrich K.L., Al-Adely S., Al-Adely S., Carmona L., Danila M.I., Gossec L., Gossec L., Izadi Z., Jacobsohn L., Katz P., Lawson-Tovey S., Lawson-Tovey S., Mateus E.F., Rush S., Schmajuk G., Simard J., Strangfeld A., Trupin L., Wysham K.D., Bhana S., Costello W., Grainger R., Hausmann J.S., Hausmann J.S., Liew J.W., Sirotich E., Sirotich E., Sufka P., Wallace Z.S., Wallace Z.S., Yazdany J., MacHado P.M., MacHado P.M., MacHado P.M., Robinson P.C., Robinson P.C. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 global rheumatology alliance physician-reported registry. Ann. Rheum. Dis. 2020;79:859–866. doi: 10.1136/annrheumdis-2020-217871. PubMed DOI PMC

Gibson P.G., Qin L., Puah S.H. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med. J. Aust. 2020;213(2):54–56. doi: 10.5694/mja2.50674. e1. PubMed DOI PMC

Giovannoni G. Disease-modifying treatments for early and advanced multiple sclerosis. Curr. Opin. Neurol. 2018;31(3):233–243. doi: 10.1097/WCO.0000000000000561. PubMed DOI

Giovannoni G., Hawkes C., Lechner-Scott J., Levy M., Waubant E., Gold J. The COVID-19 pandemic and the use of MS disease-modifying therapies. Mult. Scler. Relat. Disord. 2020;39:102073. doi: 10.1016/j.msard.2020.102073. PubMed DOI PMC

Guevara C., Villa E., Rosas C.S., Diaz V., Naves R. Treating patients with multiple sclerosis during the COVID-19 pandemic: assessing the expert recommendations. Mult. Scler. Relat. Disord. 2020;43:102224. doi: 10.1016/j.msard.2020.102224. PubMed DOI PMC

Haji Akhoundi F., Sahraian M.A., Naser Moghadasi A. Neuropsychiatric and cognitive effects of the COVID-19 outbreak on multiple sclerosis patients. Mult. Scler. Relat. Disord. 2020;41:102164. doi: 10.1016/j.msard.2020.102164. PubMed DOI PMC

Hobart J., Lamping D., Fitzpatrick R., Riazi A., Thompson A. The multiple sclerosis impact scale (MSIS-29) a new patient-based outcome measure. Brain. 2001;124:962–973. doi: 10.1093/brain/124.5.962. PubMed DOI

Hong J., Tejada-Simon M.V., Rivera V.M., Zang Y.C.Q., Zhang J.Z. Anti-viral properties of interferon beta treatment in patients with multiple sclerosis. Mult. Scler. 2002;8:237–242. doi: 10.1191/1352458502ms794oa. PubMed DOI

Huang I., Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J. Intensive Care. 2020;8:36. doi: 10.1186/s40560-020-00453-4. PubMed DOI PMC

Hughes R., Pedotti R., Koendgen H. COVID-19 in persons with multiple sclerosis treated with ocrelizumab – A pharmacovigilance case series. Mult. Scler. Relat. Disord. 2020;42:102192. doi: 10.1016/j.msard.2020.102192. PubMed DOI PMC

Huttner A., Eperon G., Lascano A.M., Roth S., Schwob J.-M., Siegrist C.-A., Lalive P.H. Risk of MS relapse after yellow fever vaccination. Neurol. Neuroimmunol. Neuroinflamm. 2020;7(4) doi: 10.1212/NXI.0000000000000726. PubMed DOI PMC

Iovino A., Olivieri N., Aruta F., Giaquinto E., Ruggiero L., Spina E., Tozza S., Manganelli F., Iodice R. Alemtuzumab in Covid era. Mult. Scler. Relat. Disord. 2021;51:102908. doi: 10.1016/j.msard.2021.102908. PubMed DOI PMC

Jack D., Nolting A., Galazka A. Favorable outcomes after COVID-19 infection in multiple sclerosis patients treated with cladribine tablets. Mult. Scler. Relat. Disord. 2020;46:102469. doi: 10.1016/j.msard.2020.102469. PubMed DOI PMC

Jack D., Damian D., Nolting A., Galazka A. COVID-19 in patients with multiple sclerosis treated with cladribine tablets: an update. Mult. Scler. Relat. Disord. 2021;51:102929. doi: 10.1016/j.msard.2021.102929. PubMed DOI PMC

Kalincik T. Multiple sclerosis relapses: epidemiology, outcomes and management. A systematic review. Neuroepidemiology. 2015;44(4):199–214. doi: 10.1159/000382130. PubMed DOI

Kappos L., Mehling M., Arroyo R., Izquierdo G., Selmaj K., Curovic-Perisic V., Keil A., Bijarnia M., Singh A., Von Rosenstiel P. Randomized trial of vaccination in fingolimod-treated patients with multiple sclerosis. Neurology. 2015;84(9):872–879. doi: 10.1212/WNL.0000000000001302. PubMed DOI

Knoll M.D., Wonodi C. Oxford–AstraZeneca COVID-19 vaccine efficacy. Lancet. 2021;397(10269):72–74. doi: 10.1016/S0140-6736(20)32623-4. PubMed DOI PMC

Kolber M.R., Fritsch P., Price M., Singer A.G., Young J., Dugré N., Bradley S., Nickonchuk T. COVID-19 vaccine fast facts. Can. Fam. Physician. 2021;67(3):185–186. doi: 10.46747/cfp.6703185. PubMed DOI PMC

Korsukewitz C., Reddel S.W., Bar-Or A., Wiendl H. Neurological immunotherapy in the era of COVID-19 - looking for consensus in the literature. Nat. Rev. Neurol. 2020;16(9):493–505. doi: 10.1038/s41582-020-0385-8. PubMed DOI PMC

Kunkl M., Frascolla S., Amormino C., Volpe E., Tuosto L. T helper cells: the modulators of inflammation in multiple sclerosis. Cells. 2020;9:482. doi: 10.3390/cells9020482. PubMed DOI PMC

Kwong A.S.F., Pearson R.M., Adams M.J., Northstone K., Tilling K., Smith D., Fawns-Ritchie C., Bould H., Warne N., Zammit S., Gunnell D.J., Moran P.A., Micali N., Reichenberg A., Hickman M., Rai D., Haworth S., Campbell A., Altschul D., Flaig R., McIntosh A.M., Lawlor D.A., Porteous D., Timpson N.J. Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts. Br. J. Psychiatry. 2020;1–10 doi: 10.1192/bjp.2020.242. PubMed DOI PMC

Lai B., Chiu C.Y., Pounds E., Tracy T., Mehta T., Young H.J., Riser E., Rimmer J. COVID-19 modifications for remote teleassessment and teletraining of a complementary alternative medicine intervention for people with multiple sclerosis: protocol for a randomized controlled trial. JMIR Res. Protoc. 2020;9:e18415. doi: 10.2196/18415. PubMed DOI PMC

Lattanzi S., Cagnetti C., Danni M., Provinciali L., Silvestrini M. Oral and intravenous steroids for multiple sclerosis relapse: a systematic review and meta-analysis. J. Neurol. 2017;264(8):1697–1704. doi: 10.1007/s00415-017-8505-0. PubMed DOI

Learmonth Y.C., Motl R.W., Sandroff B.M., Pula J.H., Cadavid D. Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis. BMC Neurol. 2013;13:37. doi: 10.1186/1471-2377-13-37. PubMed DOI PMC

Liu S., Liu X., Chen S., Xiao Y., Zhuang W. Oral versus intravenous methylprednisolone for the treatment of multiple sclerosis relapses: A meta-analysis of randomized controlled trials. PLoS One. 2017;12 doi: 10.1371/journal.pone.0188644. PubMed DOI PMC

Livingston E., Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA. 2020;323(14):1335. doi: 10.1001/jama.2020.4344. PubMed DOI

Loonstra F.C., Hoitsma E., van Kempen Z.L.E., Killestein J., Mostert J.P. COVID-19 in multiple sclerosis: the Dutch experience. Mult. Scler. J. 2020;26(10):1256–1260. doi: 10.1177/1352458520942198. PubMed DOI PMC

Louapre C., Collongues N., Stankoff B., Giannesini C., Papeix C., Bensa C., Deschamps R., Créange A., Wahab A., Pelletier J., Heinzlef O., Labauge P., Guilloton L., Ahle G., Goudot M., Bigaut K., Laplaud D.-A., Vukusic S., Lubetzki C., De Sèze J. Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis. JAMA Neurol. 2020;77(9):1079–1088. doi: 10.1001/jamaneurol.2020.2581. PubMed DOI PMC

Maghzi A.H., Houtchens M.K., Preziosa P., Ionete C., Beretich B.D., Stankiewicz J.M., Tauhid S., Cabot A., Berriosmorales I., Schwartz T.H.W., Sloane J.A., Freedman M.S., Filippi M., Weiner H.L., Bakshi R. COVID-19 in teriflunomide-treated patients with multiple sclerosis. J. Neurol. 2020;267(10):2790–2796. doi: 10.1007/s00415-020-09944-8. PubMed DOI PMC

Mansoor S., Kelly S., Murphy K., Waters A., Siddiqui N.S. COVID-19 pandemic and the risk of infection in multiple sclerosis patients on disease modifying therapies: “what the bleep do we know?” Egypt. J. Neurol. Psychiatry Neurosurg. 2020;56(1):44. doi: 10.1186/s41983-020-00177-0. PubMed DOI PMC

Marrodan M., Alessandro L., Farez M.F., Correale J. The role of infections in multiple sclerosis. Mult. Scler. 2019;25:891–901. doi: 10.1177/1352458518823940. PubMed DOI

Mateen F.J. Multiple sclerosis in resource-limited settings: research opportunities in an unequal world. Neurology. 2019;93(4):176–180. doi: 10.1212/WNL.0000000000007837. PubMed DOI

Mateen F.J., Rezaei S., Alakel N., Gazdag B., Kumar A.R., Vogel A. Impact of COVID-19 on U.S. and Canadian neurologists’ therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices. J. Neurol. 2020;267(12):3467–3475. doi: 10.1007/s00415-020-10045-9. PubMed DOI PMC

Matías-Guiu J., Montero-Escribano P., Pytel V., Porta-Etessam J., Matias-Guiu J.A. Potential COVID-19 infection in patients with severe multiple sclerosis treated with alemtuzumab. Mult. Scler. Relat. Disord. 2020;44:102297. doi: 10.1016/j.msard.2020.102297. PubMed DOI PMC

McCarthy C.L., Tuohy O., Compston D.A.S., Kumararatne D.S., Coles A.J., Jones J.L. Immune competence after alemtuzumab treatment of multiple sclerosis. Neurology. 2013;81(10):872–876. doi: 10.1212/WNL.0b013e3182a35215. PubMed DOI PMC

Mehta N.S., Mytton O.T., Mullins E.W.S., Fowler T.A., Falconer C.L., Murphy O.B., Langenberg C., Jayatunga W.J.P., Eddy D.H., Nguyen-Van-Tam J.S. SARS-CoV-2 (COVID-19): what do we know about children? A systematic review. Clin. Infect. Dis. 2020;71(9):2469–2479. doi: 10.1093/cid/ciaa556. PubMed DOI PMC

Mishra S., Kwong J.C., Chan A.K., Baral S.D. Understanding heterogeneity to inform the public health response to COVID-19 in Canada. Can. Med. Assoc. J. 2020;192:E684–E685. doi: 10.1503/cmaj.201112. PubMed DOI PMC

Moccia M., Lanzillo R., Brescia Morra V., Bonavita S., Tedeschi G., Leocani L., Lavorgna L. Assessing disability and relapses in multiple sclerosis on tele-neurology. Neurol. Sci. 2020;41:1369–1371. doi: 10.1007/s10072-020-04470-x. PubMed DOI PMC

MS International Federation The Coronavirus and MS – Updated Global Advice. 2020. https://www.msif.org/news/2020/02/10/the-coronavirus-and-ms-what-you-need-to-know/ (accessed 7.21.20)

Nalbandian A., Sehgal K., Gupta A., Madhavan M.V., McGroder C., Stevens J.S., Cook J.R., Nordvig A.S., Shalev D., Sehrawat T.S., Ahluwalia N., Bikdeli B., Dietz D., Der-Nigoghossian C., Liyanage-Don N., Rosner G.F., Bernstein E.J., Mohan S., Beckley A.A., Seres D.S., Choueiri T.K., Uriel N., Ausiello J.C., Accili D., Freedberg D.E., Baldwin M., Schwartz A., Brodie D., Garcia C.K., Elkind M.S.V., Connors J.M., Bilezikian J.P., Landry D.W., Wan E.Y. Post-acute COVID-19 syndrome. Nat. Med. 2021;27(4):601–615. doi: 10.1038/s41591-021-01283-z. PubMed DOI PMC

Parrotta E., Kister I., Charvet L., Sammarco C., Saha V., Charlson R.E., Howard J., Gutman J.M., Gottesman M., Abou-Fayssal N., Wolintz R., Keilson M., Fernandez-Carbonell C., Krupp L.B., Zhovtis Ryerson L. COVID-19 outcomes in MS: observational study of early experience from NYU multiple sclerosis comprehensive care center. Neurol. Neuroimmunol. Neuroinflamm. 2020;7(5) doi: 10.1212/NXI.0000000000000835. 2020 Jul 9. e835. PubMed DOI PMC

Peeters L.M., Parciak T., Walton C., Geys L., Moreau Y., De Brouwer E., Raimondi D., Pirmani A., Kalincik T., Edan G., Simpson-Yap S., De Raedt L., Dauxais Y., Gautrais C., Rodrigues P.R., McKenna L., Lazovski N., Hillert J., Forsberg L., Spelman T., McBurney R., Schmidt H., Bergmann A., Braune S., Stahmann A., Middleton R., Salter A., Bebo B.F., Rojas J.I., van der Walt A., Butzkueven H., van der Mei I., Ivanov R., Hellwig K., Sciascia do Olival, G., Cohen, J.A., Van Hecke, W., Dobson, R., Magyari, M., Brum, D.G., Alonso, R., Nicholas, R., Bauer, J., Chertcoff, A., de Sèze, J., Louapre, C., Comi, G., Rijke, N. COVID-19 in people with multiple sclerosis: A global data sharing initiative. Mult. Scler. J. 2020;26(10):1157–1162. doi: 10.1177/1352458520941485. PubMed DOI PMC

Polman C.H., O’Connor P.W., Havrdova E., Hutchinson M., Kappos L., Miller D.H., Phillips J.T., Lublin F.D., Giovannoni G., Wajgt A., Toal M., Lynn F., Panzara M.A., Sandrock A.W. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N. Engl. J. Med. 2006;354:899–910. doi: 10.1056/NEJMoa044397. PubMed DOI

Portaccio E., Fonderico M., Hemmer B., Derfuss T., Stankoff B., Selmaj K., Tintorè M., Amato M.P. Impact of COVID-19 on multiple sclerosis care and management: results from the European Committee for Treatment and Research in Multiple Sclerosis survey. Mult. Scler. 2021 doi: 10.1177/13524585211005339. 13524585211005339. PubMed DOI PMC

Rasmussen S.A., Smulian J.C., Lednicky J.A., Wen T.S., Jamieson D.J. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am. J. Obstet. Gynecol. 2020;222:415–426. doi: 10.1016/j.ajog.2020.02.017. PubMed DOI PMC

RECOVERY Collaborative Group Dexamethasone in Hospitalized Patients with Covid-19. N. Engl. J. Med. 2021;384(8):693–704. doi: 10.1056/NEJMoa2021436. PubMed DOI PMC

Reder A.T., Centonze D., Naylor M.L., Nagpal A., Rajbhandari R., Altincatal A., Kim M., Berdofe A., Radhakrishnan M., Jung E., Sandrock A.W., Smirnakis K., Popescu C., de Moor C. COVID-19 in patients with multiple sclerosis: associations with disease-modifying therapies. CNS Drugs. 2021;35(3):317–330. doi: 10.1007/s40263-021-00804-1. PubMed DOI PMC

Repovic P. Management of multiple sclerosis relapses. Contin. Lifelong Learn. Neurol. 2019;25(3):655–669. doi: 10.1212/CON.0000000000000739. PubMed DOI

Research Grants|National Multiple Sclerosis Society. https://www.nationalmssociety.org/For-Professionals/Researchers/Society-Funding/Research-Grants (accessed 8.21.20). 2021.

Reyes S., Ramsay M., Ladhani S., Amirthalingam G., Singh N., Cores C., Mathews J., Lambourne J., Marta M., Turner B., Gnanapavan S., Dobson R., Schmierer K., Giovannoni G. Protecting people with multiple sclerosis through vaccination. Pract. Neurol. 2020;20(6):435–445. doi: 10.1136/practneurol-2020-002527. PubMed DOI

Rohit B., Padma Srivastava M., Khurana D., Pandit L., Mathew T., Gupta S., Netravathi M., Nair S., Singh G., Singhal B. Consensus statement on immune modulation in multiple sclerosis and related disorders during the covid-19 pandemic: expert group on behalf of the indian academy of neurology. Ann. Indian Acad. Neurol. 2020;23(Suppl. 1):S5–S14. doi: 10.4103/0972-2327.282442. PubMed DOI PMC

Rudick R.A., Stuart W.H., Calabresi P.A., Confavreux C., Galetta S.L., Radue E.-W., Lublin F.D., Weinstock-Guttman B., Wynn D.R., Lynn F., Panzara M.A., Sandrock A.W. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N. Engl. J. Med. 2006;354:911–923. doi: 10.1056/NEJMoa044396. PubMed DOI

Sabatino J.J., Wilson M.R., Calabresi P.A., Hauser S.L., Schneck J.P., Zamvil S.S. Anti-CD20 therapy depletes activated myelin-specific CD8+ T cells in multiple sclerosis. Proc. Natl. Acad. Sci. U. S. A. 2019;116:25800–25807. doi: 10.1073/pnas.1915309116. PubMed DOI PMC

Safavi F., Nourbakhsh B., Azimi A.R. B-cell depleting therapies may affect susceptibility to acute respiratory illness among patients with multiple sclerosis during the early COVID-19 epidemic in Iran. Mult. Scler. Relat. Disord. 2020;43:102195. doi: 10.1016/j.msard.2020.102195. PubMed DOI PMC

Salter A., Fox R.J., Newsome S.D., Halper J., Li D.K.B., Kanellis P., Costello K., Bebo B., Rammohan K., Cutter G.R., Cross A.H. Outcomes and risk factors associated with SARS-CoV-2 infection in a North American registry of patients with multiple sclerosis. JAMA Neurol. 2021 doi: 10.1001/jamaneurol.2021.0688. e210688. PubMed DOI PMC

Shalhoub S. Interferon beta-1b for COVID-19. Lancet. 2020;395(10238):1670–1671. doi: 10.1016/S0140-6736(20)31101-6. PubMed DOI PMC

Sharma A., Bhatt N.S., St Martin A., Abid M.B., Bloomquist J., Chemaly R.F., Dandoy C., Gauthier J., Gowda L., Perales M.A., Seropian S., Shaw B.E., Tuschl E.E., Zeidan A.M., Riches M.L., Shah G.L. Clinical characteristics and outcomes of COVID-19 in haematopoietic stem-cell transplantation recipients: an observational cohort study. Lancet Haematol. 2021;8(3):e185–e193. doi: 10.1016/S2352-3026(20)30429-4. PubMed DOI PMC

Sharrack B., Saccardi R., Alexander T., Badoglio M., Burman J., Farge D., Greco R., Jessop H., Kazmi M., Kirgizov K., Labopin M., Mancardi G., Martin R., Moore J., Muraro P.A., Rovira M., Sormani M.P., Snowden J.A., Snowden J., Saccardi R., McGrath E., Bambi F., Sanchez-Guijo F., Worel N., Snowden J., Alexander T., Badolglio M., Abinun M., Arnold R., Brierley C., Burman J., Castilla-Llorente C., Cooper N., Daikeler T., del Papa N., Farge D., Finke J., Greco R., Hagglund H., Henes J., Hiepe F., Jessop H., Kiely D., Labopin M., Kazmi M., Kirgizov K., Mancardi G., Marjanovic Z., Martin R., Martin T., Ma D., Moore J., Miller P., Muraro P., Oliveira M.C., Polushin A., Onida F., Simoes B., Puyade M., Resnick I., Rovira M., Saccardi R., Saif M., Sakellari I., Sharrack B., Snarski E., Scherer H.U., Sossa C., de Vries-Bouwstra J., Wulffraat N., Zaccara E. Autologous haematopoietic stem cell transplantation and other cellular therapy in multiple sclerosis and immune-mediated neurological diseases: updated guidelines and recommendations from the EBMT autoimmune diseases working party (ADWP) and the joint accreditation committee of EBMT and ISCT (JACIE) Bone Marrow Transplant. 2020;55:283–306. doi: 10.1038/s41409-019-0684-0. PubMed DOI PMC

Simpson-Yap S., De Brouwer E., Kalincik T., Rijke N., Hillert J., Walton C., Edan G., Moreau Y., Spelman T., Geys L., Parciak T., Gautrais C., Lazovski N., Pirmani A., Ardeshirdavani A., Forsberg L., Glaser A., McBurney R., Schmidt H., Bergmann A., Braune S., Stahmann A., Middleton R., Salter A., Fox R.J., van der Walt A., Butzkueven H., Al-Roughani R., Ozakbas S., Rojas J.I., van der Mei I., Nag N., Ivanov R., do Olival G.S., Dias A.E., Magyari M., Guimarães Brum D., Mendes M.F., Alonso R., Nicholas R., Bauer J., Chertcoff A., Zabalza A., Arrambide G., Fidao A., Comi G., Peeters L.M. Associations of DMT therapies with COVID-19 severity in multiple sclerosis. medRxiv. 2021 doi: 10.1101/2021.02.08.21251316. PubMed DOI PMC

Sormani M.P. An Italian programme for COVID-19 infection in multiple sclerosis. Lancet Neurol. 2020;19(6):481–482. doi: 10.1016/S1474-4422(20)30147-2. PubMed DOI PMC

Sormani M.P., De Rossi N., Schiavetti I., Carmisciano L., Cordioli C., Moiola L., Radaelli M., Immovilli P., Capobianco M., Trojano M., Zaratin P., Tedeschi G., Comi G., Battaglia M.A., Patti F., Salvetti M. Disease modifying therapies and COVID-19 severity in multiple sclerosis. SSRN Electron. J. 2020 doi: 10.2139/ssrn.3631244. PubMed DOI

Sundaram M.E., Calzavara A., Mishra S., Kustra R., Chan A.K., Hamilton M.A., Djebli M., Rosella L.C., Watson T., Chen H., Chen B., Baral S.D., Kwong J.C. Individual and social determinants of SARS-CoV-2 testing and positivity in Ontario, Canada: a population-wide study. Can. Med. Assoc. J. 2021 doi: 10.1503/cmaj.202608. 202608. PubMed DOI PMC

Taylor P.C., Adams A.C., Hufford M.M., de la Torre I., Winthrop K., Gottlieb R.L. Neutralizing monoclonal antibodies for treatment of COVID-19. Nat. Rev. Immunol. 2021 doi: 10.1038/s41577-021-00542-x. PubMed DOI PMC

triMSx: Managing MS during the COVID-19 pandemic triMS.online – Treatment and Research in Multiple Sclerosis online. 2020. https://www.trimsonlineconference.com/managing-ms-during-the-covid-19-pandemic (accessed 7.21.20)

Ufer M., Shakeri-Nejad K., Gardin A., Su Z., Paule I., Marbury T.C., Legangneux E. Impact of siponimod on vaccination response in a randomized, placebo-controlled study. Neurol. Neuroimmunol. Neuroinflamm. 2017;4(6) doi: 10.1212/NXI.0000000000000398. 13. e398. PubMed DOI PMC

Vogel A.C., Schmidt H., Loud S., McBurney R., Mateen F.J. Impact of the COVID-19 pandemic on the health care of >1,000 people living with multiple sclerosis: a cross-sectional study. Mult. Scler. Relat. Disord. 2020;46:102512. doi: 10.1016/j.msard.2020.102512. PubMed DOI PMC

Waghmare A., Abidi M.Z., Boeckh M., Chemaly R.F., Dadwal S., El Boghdadly Z., Kamboj M., Papanicolaou G.A., Pergam S.A., Shahid Z. Guidelines for COVID-19 management in hematopoietic cell transplantation and cellular therapy recipients. Biol. Blood Marrow Transplant. 2020;26(11):1983–1994. doi: 10.1016/j.bbmt.2020.07.027. PubMed DOI PMC

Waldman G., Mayeux R., Claassen J., Agarwal S., Willey J., Anderson E., Punzalan P., Lichtcsien R., Bell M., Przedborski S., Ulane C., Roberts K., Williams O., Lassman A.B., Lennihan L., Thakur K.T. Preparing a neurology department for SARS-CoV-2 (COVID-19): early experiences at Columbia University Irving Medical Center and the New York Presbyterian Hospital in New York City. Neurology. 2020;94:886–891. doi: 10.1212/WNL.0000000000009519. PubMed DOI PMC

Wastnedge E.A.N., Reynolds R.M., van Boeckel S.R., Stock S.J., Denison F.C., Maybin J.A., Critchley H.O.D. Pregnancy and COVID-19. Physiol. Rev. 2021;101(1):303–318. doi: 10.1152/physrev.00024.2020. PubMed DOI PMC

Waubant E., Banwell B., Wassmer E., Sormani M.P., Amato M.P., Hintzen R., Krupp L., Rostásy K., Tenembaum S., Chitnis T. Clinical trials of disease-modifying agents in pediatric MS: opportunities, challenges, and recommendations from the IPMSSG. Neurology. 2019;92:E2538–E2549. doi: 10.1212/WNL.0000000000007572. PubMed DOI PMC

Williamson E.J., Walker A.J., Bhaskaran K., Bacon S., Bates C., Morton C.E., Curtis H.J., Mehrkar A., Evans D., Inglesby P., Cockburn J., McDonald H.I., MacKenna B., Tomlinson L., Douglas I.J., Rentsch C.T., Mathur R., Wong A.Y.S., Grieve R., Harrison D., Forbes H., Schultze A., Croker R., Parry J., Hester F., Harper S., Perera R., Evans S.J.W., Smeeth L., Goldacre B. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature. 2020;584(7821):430–436. doi: 10.1038/s41586-020-2521-4. PubMed DOI PMC

World Health Organization (WHO) The Safety of Medicines in Public Health Programmes. 2013. https://www.who.int/hiv/pub/pharmacovigilance/safety/en/ (accessed 8.23.20)

World Health Organization (WHO) Advice for the Public. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public (accessed 7.21.20)

Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323:1239–1242. doi: 10.1001/jama.2020.2648. PubMed DOI

Yam C., Jokubaitis V., Hellwig K., Dobson R. MS, pregnancy and COVID-19. Mult. Scler. 2020;26(10):1137–1146. doi: 10.1177/1352458520949152. PubMed DOI PMC

Yang J., Zheng Y., Gou X., Pu K., Chen Z., Guo Q., Ji R., Wang H., Wang Y., Zhou Y. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: A systematic review and meta-analysis. Int. J. Infect. Dis. 2020;94:91–95. doi: 10.1016/j.ijid.2020.03.017. PubMed DOI PMC

Yeroushalmi S., Maloni H., Costello K., Wallin M.T. Telemedicine and multiple sclerosis: a comprehensive literature review. J. Telemed. Telecare. 2019;26(7–8):400–413. doi: 10.1177/1357633X19840097. PubMed DOI

Zabalza A., Cárdenas-Robledo S., Tagliani P., Arrambide G., Otero-Romero S., Carbonell-Mirabent P., Rodriguez-Barranco M., Rodríguez-Acevedo B., Restrepo Vera J.L., Resina-Salles M., Midaglia L., Vidal-Jordana A., Río J., Galan I., Castillo J., Cobo-Calvo Á., Comabella M., Nos C., Sastre-Garriga J., Tintore M., Montalban X. COVID-19 in multiple sclerosis patients: susceptibility, severity risk factors and serological response. Eur. J. Neurol. 2020;00:1–13. doi: 10.1111/ene.14690. PubMed DOI

Hatcher-Martin JM, Busis NA, Cohen BH, Wolf RA, Jones EC, Anderson ER, Fritz JV, Shook SJ, Bove RM., 2021. American Academy of Neurology Telehealth Position Statement. Neurology.10.1212/WNL.0000000000012185. doi:10.1212/WNL.0000000000012185. PubMed PMC

Zambrano, L.D., Ellington, S., Strid, P., Galang, R.R., Oduyebo, T., Tong, V.T., Woodworth, K.R., Nahabedian, J.F., Azziz-Baumgartner, E., Gilboa, S.M., Meaney-Delman, D., Akosa, A., Bennett, C., Burkel, V., Chang, D., Delaney, A., Fox, C., Griffin, I., Hsia, J., Krause, K., Lewis, E., Manning, S., Mohamoud, Y., Newton, S., Neelam, V., Olsen, E.O., Perez, M., Reynolds, M., Riser, A., Rivera, M., Roth, N.M., Sancken, C., Shinde, N., Smoots, A., Snead, M., Wallace, B., Whitehill, F., Whitehouse, E., Zapata, L., 2020. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status — United States, January 22–October 3, 2020. MMWR Morb. Mortal. Wkly Rep. 69, 1641–1647.doi:10.15585/mmwr.mm6944e3. PubMed DOI PMC

Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z., Xiang J., Wang Y., Song B., Gu X., Guan L., Wei Y., Li H., Wu X., Xu J., Tu S., Zhang Y., Chen H., Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. doi: 10.1016/S0140-6736(20)30566-3. PubMed DOI PMC

Zimmermann P., Curtis N. Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr. Infect. Dis. J. 2020;39(5):355–368. doi: 10.1097/INF.0000000000002660. PubMed DOI PMC

COVID-19 and multiple sclerosis: challenges and lessons for patient care

Anti-SARS-CoV-2 vaccination in people with multiple sclerosis: Lessons learnt a year in