From: “Neurological manifestations of COVID-19” - guideline of the German society of neurology
Substance | Diseases | General Recommendation during pandemic | Specific recommendations in case of infection |
---|---|---|---|
DNA-synthesis Interference strategies | |||
Azathioprin | MG, NMOSD, PACNS, IIM, AIE, Vasculitis, Neurosarcoidosis | Continuation | Discontinuation |
Methotrexate | MG, NMOSD, PACNS, IIM, AIE, Vasculitis, Neurosarcoidosis | Continuation | Discontinuation |
Cyclophosphamid | PACNS, AIE, Vasculitis, Collagene vascular disease | Continuation, in case of longterm stable disease de-escalation | Discontinuation |
Mitoxantron | SPMS | Alternative treatments, in case of longterm stable disease: dose-reduction or termination | Discontinuation |
Teriflunomid | RRMS | Continuation | Continuation, in case of severe lymphopenia discontinuation |
Mycophenolat-Mofetil | MG, NMOSD, PACNS, IIM, Vasculitis, Neurosarcoidosis | Continuation | Continuation, in case of severe lymphopenia discontinuation |
Cladribin | RRMS | Delay next treatment cycle | Discontinue, look for alternate treatment |
Immune cell depletion strategies | |||
Rituximab | MG, NMOSD, PACNS, IIM, AIE, CNS-Vasculitis, CIDP | Delay next treatment cycle; CD19-B-Zell-Monitoring | Discontinue, look for alternate treatment |
Ocrelizumab | RRMS, PPMS | Delay next treatment cycle; CD19-B-Zell-Monitoring | Discontinue, look for alternate treatment |
Inebilizumab | NMOSD | Delay next treatment cycle; CD19-B-Zell-Monitoring | Discontinue, look for alternate treatment |
Alemtuzumab | RRMS | Delay next treatment cycle; CD19-B-Zell-Monitoring | Discontinue, look for alternate treatment |
Leucocyte sequestration | |||
Fingolimod/Ozanimod | RRMS | Continuation | Continue, or discontinuation for a few weeks |
Siponimod | SPMS | Continuation | Continue, or discontinuation for a few weeks |
Natalizumab | RRMS | Continuation or delay of treatment cycle | Continuation or delay of treatment cycle |
Pleiotropic Immunomodulation | |||
Glatirameracetat | RRMS | Continuation | Continuation |
Dimethylfumarat | RRMS | Continuation Severe Lymphopenia: Discontinue | Continuation Severe Lymphopenia: Discontinue |
Cytokines | |||
IFN-β | RRMS, SPMS | Continuation | Continuation |
Tocilizumab/Satralizumab | NMOSD | Continuation | Continuation |
Complement inhibitors | |||
Eculizumab | MG, NMOSD | Continuation | Continuation |
Intracellular pathway Blockers | |||
Ciclosporin A | MG, IIM | Continuation | Continuation, dose reduction |
Acute therapies | |||
Steroid pulse therapy | MS, MG, NMOSD, PACNS, IIM, AIE, Vasculitis, Neurosarcoidosis | Only in case of high disease activity | Discontinuation or dose reduction |
Chronic glucosteroid therapy | NMOSD, MG, PACNS, IIM, CIDP, Vasculitis, Neurosarcoidosis | Dose reduction | Stable disease: Dose reduction |
IVIG | MG, IIM, CIDP, GBS | Continuation or delay of treatment cycle | Continuation or delay of treatment cycle |
Plasmapheresis/Immuno-adsorption | MS, MG, NMOSD, AIE, IIM, GBS | Continuation | Continuation |