Impact of immunotherapies on COVID-19 outcomes in multiple sclerosis patients

SARS-CoV-2 pandemic has led the scientific community to maximize efforts to prevent infections and disease severity in patients with multiple sclerosis (pwMS). We analyze the impact of immunotherapies on COVID-19 outcomes in pwMS, providing our interpretation of data.

Infections, hospitalizations, intensive care unit admissions, and death rates in COVID-19 pwMS are comparable to the general population. Severity of disability, MS clinical phenotype, age, and comorbidities, along with the use of intravenous methylprednisolone and anti-CD20 treatments, are risk factors for COVID-19 severity. Disease-modifying treatments (DMTs) can be safely started and continued during the pandemic. Benefit-risk evaluation is mandatory when managing second-line therapies to balance risk of worse COVID-19 outcomes and MS reactivation. COVID-19 vaccination is safe in MS, and its efficacy could be reduced in fingolimod- and ocrelizumab-treated patients.

The rate of (re)-infection and outcomes with SARS-CoV-2 variants in pwMS and antiviral properties of DMTs need to be further explored. Data on COVID-19 in pregnant MS women, children, and elderly pwMS are limited. Evidence on long-term effects of infection is needed. Impact of emerging DMTs on COVID-19 should be investigated. More data and longer follow-up are needed to characterize long-term efficacy and safety profile of vaccinations in pwMS.