2019冠状病毒病(COVID-19)大流行预计将持续。关于开始或继续对多发性硬化症进行疾病修饰治疗的决定必须考虑到与大流行的潜在相关性。在这一特殊时期,了解其作用机制和每种治疗药物对免疫系统可能的独特作用是非常必要的。在选择一种新的治疗方法或决定现有治疗的风险缓解策略时,应仔细考虑感染副作用以及每种治疗药物的给药途径和频率。更重要的是,在治疗决定时应仔细考虑每种制剂对未来严重急性呼吸综合征冠状病毒-2型(SARS-CoV-2)疫苗的影响。此外,一些多发性硬化症治疗可能对SARS-CoV-2有有益的抗病毒作用,而另一些可能对疾病的细胞因子风暴和高炎性阶段有有益的免疫调节作用。常规注射剂具有良好的免疫特性,不会增加暴露风险,因此可能适合大流行期间轻度多发性硬化症。然而,中度和高度活动性多发性硬化症将继续需要口服或静脉注射强效药物治疗,但可能需要实施一些风险缓解策略。从免疫特性的角度来看,免疫调节疗法,如烟酸盐、鞘氨醇- 1p调节剂和纳塔珠单抗,在大流行期间可能比细胞消耗免疫抑制剂更受青睐。在细胞消耗药物中,选择性(奥克里珠单抗)或优先(克拉德里滨)消耗B细胞可能比非选择性消耗淋巴细胞和先天免疫细胞(阿仑妥珠单抗)相对安全。 Patients who develop severe iatrogenic or idiosyncratic lymphopenia should be advised to maintain social distancing even in areas where lockdown has been removed or ameliorated. Patients with iatrogenic hypogammaglobulinemia may require prophylactic intravenous immunoglobulin therapy in certain situations. When the future SARS-CoV-2 vaccine becomes available, patients with multiple sclerosis should be advised that certain therapies may interfere with mounting a protective immune response to the vaccine and that serological confirmation of a response may be required after vaccination. They should also be aware that most multiple sclerosis therapies are incompatible with live vaccines if a live SARS-CoV-2 vaccine is developed. In this article, we review and compare disease-modifying therapies in terms of their effect on the immune system, published infection rates, potential impact on SARS-CoV-2 susceptibility, and vaccine-related implications. We propose risk mitigation strategies and practical approaches to disease-modifying therapy during the COVID-19 pandemic.

参考文献

PubMed.