Table 1.
Consensus on management of neuroimmunological disease during the COVID-19 pandemic
| Question no. | Question | Answer | Consensusa |
|---|---|---|---|
| More than ten recommendations, consensus ≥90% | |||
| 1 | Should patients with neuroimmunological disease follow local recommendations? | Patients with neuroimmunological disease should follow the general local recommendations of social distancing, regular hand washing and/or disinfection, and avoiding public transport | 20/20 (100%) |
| 2 | Should patients with functionally relevant disease deterioration be treated with corticosteroids? | Patients with an acute deterioration and relevant neurological deficits should be treated with a steroid pulse if there are no indications of SARS-CoV-2 infection | 12/12 (100%) |
| 3 | Should patients without SARS-CoV-2 infection stop immune therapy? | Patients who are on a stable immunotherapy and who do not have signs of SARS-CoV-2 infection should not stop treatment because of the COVID-19 pandemic | 19/20 (95%) |
| 4 | Are patients who are receiving IFNβ at increased risk of SARS-CoV-2 infection? | Treatment with IFNβ should not increase the risk of SARS-CoV-2 infection | 13/13 (100%) |
| 5 | Are patients who are receiving glatiramer acetate at increased risk of SARS-CoV-2 infection? | Treatment with glatiramer acetate should not increase the risk of SARS-CoV-2 infection | 13/13 (100%) |
| 6 | Are patients who are receiving fingolimod or siponimod at increased risk of SARS-CoV-2 infection? | Treatment with fingolimod or siponimod might increase the risk of SARS-CoV-2 infection | 14/15 (93%) |
| 7 | Are patients who are receiving B cell-depleting therapies at increased risk of SARS-CoV-2 infection? | Treatment with B cell-depleting therapies might increase the risk of SARS-CoV-2 infection | 14/14 (100%) |
| 8 | Are patients who are receiving alemtuzumab at increased risk of SARS-CoV-2 infection? | Treatment with alemtuzumab might increase the risk of SARS-CoV-2 infection | 14/14 (100%) |
| 9 | Are patients who are receiving cladribine at increased risk of SARS-CoV-2 infection? | Treatment with cladribine might increase the risk of SARS-CoV-2 infection. | 15/15 (100%) |
| 10 | Should patients start a DMT during the COVID-19 pandemic? | Treatment initiation is possible; the decision to initiate a DMT in patients with newly diagnosed mild to moderate MS should be based on a discussion that balances disease-related, therapy-related and COVID-19 pandemic-related factors | 11/12 (92%) |
| 11 | Should patients start an intensive (highly effective) therapy during the COVID-19 pandemic? | Treatment initiation is possible; the decision to initiate a DMT in patients with newly diagnosed (highly) active MS should be based on a discussion that balances disease-related, therapy-related and COVID-19 pandemic-related factors | 11/12(92%) |
| 12 | Should the next cycle of a therapy with a long treatment interval be delayed during the COVID-19 pandemic? | Delay of the next cycle of a therapy with a long treatment interval should be considered | 15/15 (100%) |
| 13 | Should the next cycle of a B cell-depleting therapy be delayed during the COVID-19 pandemic? | Delay of the next cycle of a B cell-depleting therapy should be considered | 12/13 (92%) |
| Fewer than ten recommendations, consensus ≥90% | |||
| 14 | Should patients with functionally relevant disease deterioration be treated with plasma exchange or IVIg? | Patients who require plasma exchange or IVIg for severe disease deterioration should be treated — the risk of SARS-CoV-2 infection is only slightly increased | 3/3 (100%) |
| 15 | Are patients who are receiving mitoxantrone at increased risk of SARS-CoV-2 infection? | Mitoxantrone might increase the risk of SARS-CoV-2 infection | 4/4 (100%) |
| 16 | Are patients who have undergone HSCT at increased risk of SARS-CoV-2 infection? | Patients who have undergone HSCT within the past 6–12 months have an increased risk of SARS-CoV-2 infection | 4/4 (100%) |
| 17 | Should patients with MS have vaccinations during the COVID-19 pandemic? | Patients with MS should have vaccinations against influenza and pneumococcus during the COVID-19 pandemic | 2/2 (100%) |
| Ten or more recommendations, consensus ≥70% but <90% | |||
| 18 | Are patients who are receiving natalizumab at increased risk of SARS-CoV-2 infection? | Natalizumab should not increase the risk of SARS-CoV-2 infection | 10/13 (77%) |
| Fewer than ten recommendations, consensus ≥70% but <90% | |||
| 19 | Are patients with neuroimmunological disease at increased risk of SARS-CoV-2 infection? | Patients who have neuroimmunological diseases without respiratory symptoms, severe disability or dysphagia should not be at increased risk of SARS-CoV-2 infection besides any effects of immunosuppressive therapy | 7/9 (78%) |
| Ten or more recommendations addressing the topic, consensus <70% | |||
| 20 | Are patients who are receiving teriflunomide at increased risk of SARS-CoV-2 infection? | Treatment with teriflunomide should not increase the risk of SARS-CoV-2 infection | 8/12 (67%) |
| 21 | Are patients who are receiving dimethyl fumarate at increased risk of SARS-CoV-2 infection? | Treatment with dimethyl fumarate should not increase the risk of SARS-CoV-2 infection | 7/12 (58%) |
| 22 | Should patients with mild or asymptomatic COVID-19 or those who are at high risk of exposure stop immunotherapy? | Patients with mild or asymptomatic COVID-19 or who are at high risk of exposure should stop immunotherapy | 5/12 (42%) |
Consensus calculated via a Delphi-like process. See Supplementary Table 1 for national and international recommendations and opinion publications on which the consensus is based. COVID-19, coronavirus disease 2019; DMT, disease-modifying therapy; HSCT, haematopoietic stem cell therapy; IVIg, intravenous immunoglobulin; MS, multiple sclerosis; SARS-CoV-2; severe acute respiratory syndrome coronavirus 2.