Abstract:
:The coronavirus 2019 (COVID-19) pandemic is expected to linger. Decisions regarding initiation or continuation of disease-modifying therapy for multiple sclerosis have to consider the potential relevance to the pandemic. Understanding the mechanism of action and the possible idiosyncratic effects of each therapeutic agent on the immune system is imperative during this special time. The infectious side-effect profile as well as the route and frequency of administration of each therapeutic agent should be carefully considered when selecting a new treatment or deciding on risk mitigation strategies for existing therapy. More importantly, the impact of each agent on the future severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2) vaccine should be carefully considered in treatment decisions. Moreover, some multiple sclerosis therapies may have beneficial antiviral effects against SARS-CoV-2 while others may have beneficial immune-modulating effects against the cytokine storm and hyperinflammatory phase of the disease. Conventional injectables have a favorable immune profile without an increased exposure risk and therefore may be suitable for mild multiple sclerosis during the pandemic. However, moderate and highly active multiple sclerosis will continue to require treatment with oral or intravenous high-potency agents but a number of risk mitigation strategies may have to be implemented. Immune-modulating therapies such as the fumerates, sphinogosine-1P modulators, and natalizumab may be anecdotally preferred over cell-depleting immunosuppressants during the pandemic from the immune profile standpoint. Within the cell-depleting agents, selective (ocrelizumab) or preferential (cladribine) depletion of B cells may be relatively safer than non-selective depletion of lymphocytes and innate immune cells (alemtuzumab). 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.
journal_name
CNS Drugsjournal_title
CNS drugsauthors
Zheng C,Kar I,Chen CK,Sau C,Woodson S,Serra A,Abboud Hdoi
10.1007/s40263-020-00756-ysubject
Has Abstractpub_date
2020-09-01 00:00:00pages
879-896issue
9eissn
1172-7047issn
1179-1934pii
10.1007/s40263-020-00756-yjournal_volume
34pub_type
杂志文章,评审相关文献
CNS DRUGS文献大全abstract::Risperidone (Risperdal), a psychotropic atypical antipsychotic agent, is thought to act via dopamine D(2) and serotonin 5-HT(2A) receptor antagonism. The clinical efficacy of oral risperidone in the treatment of bipolar mania and schizophrenia in adult patients is well established. In the US, risperidone is also appro...
journal_title:CNS drugs
pub_type: 评论,杂志文章
doi:10.2165/00023210-200822030-00006
更新日期:2008-01-01 00:00:00
abstract::Bulimia nervosa is an eating disorder characterised by recurrent episodes of binge eating and associated efforts to purge the ingested calories through self-induced vomiting, laxative or diuretic abuse, fasting or intensive exercise. The aetiopathogenesis and pathophysiology of the disorder are currently unclear. Biol...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200115020-00004
更新日期:2001-01-01 00:00:00
abstract::Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying pat...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-015-0240-4
更新日期:2015-04-01 00:00:00
abstract::Existing drug delivery methods have not led to a significant increase in survival for patients with malignant primary brain tumors. While the combination of conventional therapies consisting of surgery, radiotherapy, and chemotherapy has improved survival for some types of brain tumors (e.g., WNT medulloblastoma), oth...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-020-00766-w
更新日期:2020-11-01 00:00:00
abstract::Assessing the risk of stroke in persons with migraine is complicated by the intricate relationship between these two conditions. Both migraine and stroke are common and co-morbidity may, in some cases, be coincidental. Given the overlap of clinical symptoms in stroke and migraine, each condition may also mimic the oth...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200519080-00004
更新日期:2005-01-01 00:00:00
abstract::Secondary progressive multiple sclerosis (SPMS) is diagnosed retrospectively and involves a clinical course characterized by a progressive accumulation of neurological disability, independent of relapses, following an initial relapsing-remitting (RR) phase. Our incomplete understanding of the pathological mechanisms u...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-016-0340-9
更新日期:2016-06-01 00:00:00
abstract::L-Dopa-induced dyskinesias (LID) are the most common adverse effects of long-term dopaminergic therapy in Parkinson's disease (PD). However, the exact mechanisms underlying dyskinesia are still unclear. For a long time, nigrostriatal degeneration and pulsatile stimulation of striatal postsynaptic receptors have been h...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-014-0205-z
更新日期:2014-12-01 00:00:00
abstract::Despite several decades of research, the characteristics distinguishing atypical depression from other depressive subtypes remain ambiguous. Multiple lines of evidence support the designation of atypical depression as a scientifically and clinically relevant subtype, including differences in hormonal responses, brain ...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/11310990-000000000-00000
更新日期:2009-12-01 00:00:00
abstract::Smokeless tobacco (SLT) is used in a variety of forms throughout the world. Long-term SLT use is associated with adverse health consequences. Effective pharmacotherapies are needed to treat SLT users who want to achieve tobacco abstinence. In the current review, we discuss the pharmacological interventions identified ...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/11598450-000000000-00000
更新日期:2012-01-01 00:00:00
abstract::Evidence-based treatment approaches for generalized anxiety disorder (GAD) comprise psychotherapy, pharmacotherapy, or a combination of the two. First-line pharmacotherapy agents include selective serotonin reuptake inhibitors, selective serotonin-norepinephrine reuptake inhibitors, and, in certain European guidelines...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-014-0162-6
更新日期:2014-06-01 00:00:00
abstract::Symptoms of anxiety and depression often appear together in patients, either as 2 discrete disorders, such as major depressive disorder and panic disorder, or as a combination of symptoms not meeting criteria for specific disorders. The social, economic, occupational and medical costs of such comorbid anxiety and depr...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.2165/00023210-199809040-00003
更新日期:1998-04-01 00:00:00
abstract::The basal ganglia and dopaminergic pathways play a central role in hyperkinetic movement disorders. Vesicular monoamine transporter 2 (VMAT2) inhibitors, which deplete dopamine at presynaptic striatal nerve terminals, are a class of drugs that have long been used to treat hyperkinetic movement disorders, but have rece...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-018-0580-y
更新日期:2018-12-01 00:00:00
abstract::The issue of antipsychotic treatment during pregnancy is subject to substantial uncertainty and some controversy among healthcare providers, specifically pertaining to second-generation antipsychotics (SGAs) that are subject to a large gap in safety data during pregnancy compared with antidepressants. The amount of sa...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-018-0517-5
更新日期:2018-04-01 00:00:00
abstract::A wide range of support is available to help smokers to quit and to aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that t...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-016-0362-3
更新日期:2016-10-01 00:00:00
abstract::The common strategy to treat a migraine attack as soon as it begins, made for classical acute antimigraine treatments such as ergotamine and analgesics, has not been transposed to the triptans. The recommendation to delay triptan intake until headache intensity is at least moderate is merely a habit generated by the p...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.2165/00023210-200115080-00001
更新日期:2001-01-01 00:00:00
abstract::The aim of this review is to provide clinicians with a picture of the mechanisms by which: histamine and histaminergic agonists act on the vestibular system both peripherally and centrally; and histaminergic agonists and antagonists interfere with the recovery process after peripheral vestibular lesion. We have focuse...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200115110-00004
更新日期:2001-01-01 00:00:00
abstract:SYNOPSIS:Mirtazapine is a tetracyclic antidepressant with a novel mechanism of action; it increases noradrenergic and serotonergic neurotransmission via blockade of central α2-adrenergic auto- and heteroreceptors. The increased release of serotonin (5-hydroxytryptamine; 5-HT) stimulates serotonin 5-HT1 receptors becaus...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.2165/00023210-199605050-00007
更新日期:1996-05-01 00:00:00
abstract::Progress in finding a better alternative to alteplase has been slow. Tenecteplase and desmoteplase have better pharmacological profiles compared with alteplase, but definite clinical evidence of their superiority is lacking. The two major phase III studies that have tested the efficacy and safety of desmoteplase in is...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.1007/s40263-015-0307-2
更新日期:2016-02-01 00:00:00
abstract::Down syndrome (DS), which results from an extra copy of chromosome 21 (trisomy 21), is the most common genetically defined cause of intellectual disability. Although no pharmacotherapy aimed at counteracting the cognitive and adaptive deficits associated with this genetic disorder has been approved at present, there h...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-013-0089-3
更新日期:2013-09-01 00:00:00
abstract::Numerous in vitro and in vivo experimental animal studies have demonstrated that gangliosides, particularly GMI ganglioside (siagoside), may stimulate or accelerate the repair of peripheral and central nervous system neurons after various types of damage. Clinical studies of GMl in peripheral neuropathies and stroke, ...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.2165/00023210-199401030-00006
更新日期:1994-03-01 00:00:00
abstract::The development of an intervention to slow or halt disease progression remains the greatest unmet therapeutic need in Parkinson's disease. Given the number of failures of various novel interventions in disease-modifying clinical trials in combination with the ever-increasing costs and lengthy processes for drug develo...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-018-0548-y
更新日期:2018-08-01 00:00:00
abstract::All current antipsychotic drugs block dopamine (DA) receptors, but the nature of the DA dysfunction in schizophrenia has not been clear. However, consistent evidence now shows that presynaptic dopaminergic function is altered in schizophrenia, specifically in terms of increased DA synthesis capacity, baseline synaptic...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-014-0177-z
更新日期:2014-07-01 00:00:00
abstract:INTRODUCTION:The use of methylphenidate for the treatment of attention deficit-hyperactivity disorder (ADHD) has increased dramatically in the past decade in some countries in Europe and North America. In response to a public debate in Israel, several Knesset members introduced a legislative initiative that aims to lim...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.2165/00023210-200317120-00005
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:When otherwise unexplained, syncope in patients with Alzheimer's disease may be attributed to bradycardia caused by cholinesterase inhibitors. We studied prospectively the clinical events and cardiovascular changes occurring during treatment with donepezil in patients with Alzheimer's disease. METHODS:Conse...
journal_title:CNS drugs
pub_type: 临床试验,杂志文章
doi:10.2165/00023210-200620050-00005
更新日期:2006-01-01 00:00:00
abstract::Naltrexone is a μ-opioid receptor antagonist that blocks the euphoric effects of heroin and prescription opioids. In order to improve treatment adherence, a once-monthly, intramuscular, extended-release formulation of naltrexone (XR-NTX) [VIVITROL(®)] has been developed, and approved in the USA and Russia for the prev...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-013-0110-x
更新日期:2013-10-01 00:00:00
abstract::Glutamatergic, noradrenergic, serotonergic, and cholinergic systems play a critical role in the basal ganglia circuitry. Targeting these non-dopaminergic receptors remains a focus of ongoing research to improve Parkinson's disease (PD) motor symptoms, without the potential side effects of dopamine replacement therapy....
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-020-00754-0
更新日期:2020-10-01 00:00:00
abstract::Antipsychotic polypharmacy refers to the co-prescription of more than one antipsychotic drug for an individual patient. Surveys of prescribing in psychiatric services internationally have identified the relatively frequent and consistent use of combined antipsychotics, usually for people with established schizophrenia...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/11587810-000000000-00000
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Antidepressant-induced liver injury is a major concern and a liver monitoring scheme has been recommended by the European Medicines Agency for agomelatine. OBJECTIVE:The objective of this study was to assess the liver safety and identify the characteristics of patients who developed a significant increase i...
journal_title:CNS drugs
pub_type: 杂志文章,meta分析
doi:10.1007/s40263-016-0351-6
更新日期:2016-09-01 00:00:00
abstract::Despite the established efficacy of chimeric antigen receptor (CAR) T-cell therapy in hematologic malignancies, translating CAR T therapy to solid tumors has remained investigational. Glioblastoma, the most aggressive and lethal form of primary brain tumor, has recently been among the malignancies being trialed clinic...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-019-00687-3
更新日期:2020-02-01 00:00:00
abstract::Duloxetine (Cymbalta) is an orally administered, selective serotonin and noradrenaline reuptake inhibitor (SNRI) that has been approved for the treatment of major depressive disorder (MDD). Based on a considerable body of evidence, duloxetine at dosages ranging from 40 to 120 mg/day was effective in the short- and lon...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200721070-00004
更新日期:2007-01-01 00:00:00