Table 3.

Potential impact of MS therapies on COVID-19 clinical course and stratification risk of MS treatment (adapted and modified from: Bhise and Dhib-Jalbut [98])

Medication	Potential benefit in COVID-19	Potential adverse effect in COVID-19	Risk of MS treatment	Currently receiving	New start
Interferon β	Reduced viral replication; inhibition of proinflammatory cytokines	Unknown	Lowest	Continue	Yes*
Glatiramer acetate	Counteract proinflammatory responses	Unknown	Lowest	Continue	Yes
Dimethyl fumarate	Reduced innate immune response to virus	Lymphopenia-related increased risk of infection and impaired viral clearance	Low	Continue	Yes
Teriflunomide	Anti-viral effect	Lymphopenia-related increased risk of infection and impaired viral clearance	Low	Continue	Yes
Fignolimod/siponimod/ozanimod	Lymphopenia may be beneficial for pneumonia and ARDS	Lymphopenia resulting in reduced viral clearance	Medium	Continue	Yes
Natalizumab	May interfere with SARS-CoV-2 host cell entry	Reduced SARS-CoV-2 clearance from the CNS and gut	Medium	Extend to 6-week intervals	Yes
Rituximab/okrelizumab/ofatumumab	Unknown	Increased risk of infection and impaired viral clearance	Medium–high	Extend interval based on B-cell counts	Yes
Cladribine	Unknown	Lymphopenia-related increased risk of infection and impaired viral clearance	High	Delay/switch	No**
Alemtuzumab	Unknown	Lymphopenia-related increased risk of infection and impaired viral clearance	High	Delay/switch	No
Hematopoietic stem cell therapy	Unknown	Unknown	High	Delay/switch	No

ARDS acute respiratory distress syndrome, CNS central nervous system

*Yes: treatment can be initiated

**No: postpone treatment