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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
  1. 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