Pulse immunosuppressive therapy for multiple sclerosis during the SARS-CoV-2 lockdown de-escalation plan: Safety...

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic significantly impacted multiple sclerosis (MS) care, leading to the suspension of disease-modifying therapies like pulse immunosuppressive therapy (PIT).
• Uncertainty regarding SARS-CoV-2 transmission from asymptomatic/presymptomatic patients receiving immunosuppressants necessitated revised treatment protocols.
• Resuming PIT is crucial for managing MS effectively during the pandemic's easing phases.

Purpose of the Study:

• To introduce a safety algorithm for the resumption of pulse immunosuppressive therapy (PIT) in multiple sclerosis (MS) patients.
• To facilitate the safe continuation of MS treatment amidst the COVID-19 pandemic.
• To prevent SARS-CoV-2 infections in healthcare settings during PIT administration.

Main Methods:

• Development of a clinical and microbiological screening algorithm based on clinical experience and published evidence.
• Integration of a symptom checklist via teleconsultation 48 hours prior to PIT.
• Inclusion of SARS-CoV-2 PCR testing from nasopharyngeal swabs 24 hours before PIT sessions.

Main Results:

• The algorithm aids in identifying contagious asymptomatic/presymptomatic individuals and those with mild SARS-CoV-2 symptoms.
• It enables the temporary withdrawal of PIT for high-risk patients, thereby preventing infections.
• The screening process aims to minimize SARS-CoV-2 transmission within day hospitals.

Conclusions:

• The developed safety algorithm demonstrates a favorable risk-benefit ratio for resuming PIT.
• Systematic PCR testing offers high sensitivity for detecting presymptomatic SARS-CoV-2 cases.
• Combining PCR testing with early symptom detection enhances patient safety and optimizes the identification of high-risk individuals before PIT administration.