“Neurological manifestations of COVID-19” - guideline of the German society of neurology

Berlit, Peter; Bösel, Julian; Gahn, Georg; Isenmann, Stefan; Meuth, Sven G.; Nolte, Christian H.; Pawlitzki, Marc; Rosenow, Felix; Schoser, Benedikt; Thomalla, Götz; Hummel, Thomas

doi:10.1186/s42466-020-00097-7

Neurological Research and Practice

Table 1 Overview of the most frequently applied immunotherapies for neurological diseases and corresponding recommendations regarding their application in times of COVID-19

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

AIE autoimmune encephalitis, GBS Guillain-Barré syndrome, CIDP chronic inflammatory demyelinating polyneuropathy, IFN-ß interferon-beta, IIM idiopathic inflammatory myopathy, IVIG intravenous immunoglobulins, MG myasthenia gravis, MS multiple sclerosis, NMOSD neuromyelitis-optica spectrum disorder, PACNS primary angiitis of the central nervous system, PPMS primary chronic progressive multiple sclerosis, RRMS relapsing-remitting multiple sclerosis, SPMS secondary chronic progressive multiple sclerosis

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ISSN: 2524-3489

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