Table 1 Disease modifying therapies and their probable risk categories (https://cdn.ymaws.com/www.theabn.org/resource/collection/6750BAE6-4CBC-4DDB-A684-116E03BFE634/ABN_Guidance_on_DMTs_for_MS_and_COVID19.pdf)
Disease modifying therapy | Mechanism of action | COVID-19 risk category (https://cdn.ymaws.com/www.theabn.org/resource/collection/6750BAE6-4CBC-4DDB-A684-116E03BFE634/ABN_Guidance_on_DMTs_for_MS_and_COVID19.pdf) |
|---|---|---|
Glatiramer acetate | Shifts T cells from proinflammatory Th1 T cells to regulatory Th2 T cells reducing inflammation [6] | Safe to start or continue |
Teriflunomide | Inhibiting rapidly dividing activated T cells and limited action on immune system [7] | Safe to start or continue |
Interferon beta 1a, interferon beta 1b | Suppresses expression of inflammatory cytokines and increases expression of anti-inflammatory cytokines [8] | Safe to start or continue |
Dimethyl fumarate | Activates NrF2 pathway, leading to increased humoral anti-inflammatory effects [9] | Safe to start or continue |
Natalizumab | Monoclonal antibody that blocks T lymphocyte migration to CNS by interfering with α4β1-integrin receptor molecules on the surfaces of cells [10] | Safe to start or continue with highest efficacy |
Fingolimod | Blocks release of lymphocytes acting on S1P1-5 receptor subtype [11] | Moderate risk |
Alemtuzumab | Monoclonal antibody that decreases predominantly CD-52 positive B and T cells [12] | Significant risk |
Cladribine | Disruption of proliferation of lymphocytes and apoptosis particularly depleting B cells (https://www.nature.com/articles/d42859-018-00029-1) | Significant risk |
Ocrelizumab | Selectively targets the B lymphocytes that express the CD20 antigen triggers cell death (https://www.ocrevus.com/hcp/about/moa.html) | Significant risk |
Rituximab | Selectively targets the B lymphocytes that express the CD20 antigen triggers cell death [13] | Significant risk |
Siponimod | Inhibits the migration of the lymphocytes to the location of the inflammation by binding to sphingosine-1-phosphate receptor [14] | Could pose a significant risk |
Ofatumumab | Antibody to anti-CD20 that inhibits early-stage B lymphocyte activation (https://www.centerwatch.com/directories/1067-fda-approved-drugs/listing/3172-arzerra-ofatumumab)] | Could pose a significant risk |
Hematopoietic stem cell transplantation (HSCT) | Should be postponed |