COVID-19 in teriflunomide-treated patients with multiple sclerosis
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COVID‑19 in teriflunomide‑treated patients with multiple sclerosis Amir Hadi Maghzi1 · Maria K. Houtchens1 · Paolo Preziosa2 · Carolina Ionete3 · Biljana D. Beretich4 · James M. Stankiewicz1 · Shahamat Tauhid1 · Ann Cabot5 · Idanis Berriosmorales3 · Tamara H. W. Schwartz4 · Jacob A. Sloane6 · Mark S. Freedman7 · Massimo Filippi2,8 · Howard L. Weiner1 · Rohit Bakshi1 Received: 1 May 2020 / Revised: 18 May 2020 / Accepted: 20 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The outbreak of a severe acute respiratory syndrome caused by a novel coronavirus (COVID-19), has raised health concerns for patients with multiple sclerosis (MS) who are commonly on long-term immunotherapies. Managing MS during the pandemic remains challenging with little published experience and no evidence-based guidelines. We present five teriflunomide-treated patients with MS who subsequently developed active COVID-19 infection. The patients continued teriflunomide therapy and had self-limiting infection, without relapse of their MS. These observations have implications for the management of MS in the setting of the COVID-19 pandemic. Keywords Multiple sclerosis · COVID-19 · Coronavirus · Teriflunomide · Antiviral
Introduction In late 2019, a novel enveloped RNA beta-coronavirus (SARS-CoV-2) casing a severe acute respiratory syndrome (COVID-19) emerged in Wuhan, China. In the span of a few months, this outbreak developed into a global pandemic,
* Rohit Bakshi [email protected] 1
Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Harvard Medical School, 60 Fenwood Road, Mailbox 9002L, Boston, MA 02115, USA
2
Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
3
Department of Neurology, University of Massachusetts, Worcester, MA, USA
4
Department of Neurology, Maine Medical Center, Portland, ME, USA
5
Department of Neurology, Concord Hospital, Concord, NH, USA
6
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
7
University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
8
Vita-Salute San Raffaele University, Milan, Italy
with a health care crisis, significant mortality rate, and high virulence compared to previously known viral respiratory infections [1]. While the mortality rate in the general population is reported to be approximately 2% (variable by region), individuals with chronic medical conditions and advanced age have even higher mortality [2]. Multiple strategies are under investigation for the prevention and treatment of severe COVID-19, with no vaccine or highly effective therapy currently available [3–6]. Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system that usually requires long-term immunotherapy, and affects more than 1 million Americans [7]. There are currently ~ 20 FDA-approved disease-modifying therapies (DMTs) for the
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