Table 2.
Summary table of expert consensus of IAN for use of Immunomodulators during the COVID 19 Pandemic in patients with MS, NMO and MOG-related Disorders in Non-COVID positive patients
| Medications | Therapy in newly diagnosed patients | Maintenance Therapy in already diagnosed patients |
|---|---|---|
| Multiple Sclerosis | ||
| Pulse steroids ( for relapse) | Yes | No |
| Plasmapheresis (for severe relapse in select cases) | Yes. Limited evidence.[39,40,41] | No. |
| IVIG ( for severe relapse in select cases) | Uncertain. Limited evidence.[39,40,42,43] | Limited evidence. Uncertain benefit.[42,43] |
| Interferons | Yes | Yes |
| Glatiramer | Yes | Yes |
| Dimethyl fumarate | Yes | Yes |
| Teriflunomide** | Yes (With caution) | Yes |
| Fingolimod | No | Yes |
| Natalizumab | Yes | Yes |
| Alemtuzumab | No | Withhold/delay |
| Ocrelizumab | No | Withhold/delay |
| Rituximab | No | Withhold/delay |
| Azathioprine | No | Yes |
| Mycophenolate Mofetil | No | Yes |
| NMOSD, MOG and related disorders | ||
| Steroids | Relapse: Yes | ##,^^ Possibly (With Close Monitoring. Consider alternate if possible) |
| Plasmapheresis | Relapse: Yes.[41,44,45,46,47,48] | Yes (Could Be Considered As An Option During The Current Pandemic, Weighing The Feasibility And Potential Risk Of Infection, frequent visits and Hospitalisation ) |
| IVIG | Relapse: Yes.[43,45,47,48,49,50] | Yes (Could Be Considered as a Safe Option During The Current Pandemic. Consider cost and feasibility)[43,45,47,48,49,50] |
| Rituximab | Uncertainty exists. Could be potentially considered in individual circumstances, in view of risk of preventing breakthrough disease versus risk of COVID 19 infection if no other option seems feasible. Discussion with infectious disease expert is important. | Prudent to delay if patient is stable. Could monitor CD19/20/ and CD 27 (if available) blood cell counts.[51,52] |
| Azathioprine | No | Yes |
| Mycophenolate Mofetil | No | Yes |
**This has been considered to be a potential therapy that can be offered to a newly detected patient by other advisory summaries listed above.[13,14,20]. ## For patients who have been on low dose maintenance, it must be taken into consideration if any other long-term immunosuppression is being given and risk of relapse. Accordingly depending upon the dose, modification or withdrawal of the therapy could be decided. ^^ Low dose maintenance has also been suggested as a continuation treatment during this pandemic in absence of alternate treatment for patients where immunosuppressive therapy has to be stopped or delayed.[20]