Multiple sclerosis treatment during the COVID-19 pandemic

master's thesis

• Title (croatian): Liječenje multiple skleroze tijekom pandemije COVID-19
• Author: Anna Safiulin
• Mentor: Tereza Gabelić (mentor)
• Committee member: Tereza Gabelić (predsjednik povjerenstva)
• Committee member: Barbara Barun (član povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2021-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS), and the current
treatment is centered on immunomodulatory and immunosuppressive medications. The ongoing COVID-
19 pandemic has raised concerns about the risk of infection in the general population and vulnerable patients
such as those with MS. High-dose pulse steroid therapy and disease-modifying treatments (DMTs) modify
the immune response, and concerns have been raised about the effects of these treatments may have on
COVID-19 outcomes.
MS and COVID-19 share immune system dysfunction, characterized by the inappropriate activity of major
immune cells, such as T lymphocytes, and their imbalance in the level of released anti- and proinflammatory
cytokines. Therefore, it is reasonable to draw some conclusions regarding the influence of
MS medications on COVID-19 using data from international registries of COVID-19 among patients with
multiple sclerosis (pwMS) and known pharmacology of DMTs.
There is no single therapy that is successful in all cases of COVID-19 disease, and vaccination is the best
strategy to combat the pandemic. Some DMTs may reduce the vaccine's effectiveness, although they may
still give some protection against COVID-19 infection. A risk/benefit analysis should be performed before
a decision is made about when to provide the vaccination and whether to defer the administration of the
DMT dosage or not.

Abstract (croatian)

Multipla skleroza (MS) je autoimuna bolest središnjeg živčanog sustava (CNS), a trenutno liječenje
usmjereno je na imunomodulatorne i imunosupresivne lijekove. Pandemija COVID-19 koja je u tijeku
izazvala je zabrinutost zbog rizika od infekcije u općoj populaciji te kod ranjivih bolesnika poput onih s
MS-om. Terapija visokim pulsnim dozama kortikosteroida kao i lijekovima koji modificiraju tijek bolesti
(DMT) vezana je uz moguće negativne učinke koje navedeno liječenje može imati na ishode COVID-19
infekcije.
MS i COVID-19 dijele disfunkciju imunološkog sustava, koju karakterizira neprikladna aktivnost glavnih
imunoloških stanica, kao što su T limfociti, te njihova neravnoteža u razini oslobođenih protuupalnih i
proupalnih citokina. Stoga je razumno donijeti neke zaključke o utjecaju lijekova za MS na COVID-19
koristeći podatke međunarodnih registara osoba s MS-om oboljelih od COVID-19 te poznate farmakologije
različitih DMT-a.
Ne postoji jedinstvena terapija koja je uspješna u svim slučajevima bolesti COVID-19, a cijepljenje je
najbolja strategija za borbu protiv pandemije. Neki DMT-i mogu smanjiti učinkovitost cjepiva, iako i dalje
mogu pružiti određenu zaštitu od infekcije COVID-19. Prije donošenja odluke o tome kada provesti
cijepljenje i treba li odgoditi primjenu doze DMT-a ili ne, potrebno je provesti analizu rizika/koristi.

• Keywords: Disease-modifying therapy; Multiple sclerosis; COVID-19 pandemic; Vaccines
• Keywords (croatian): terapija koja modificira bolest; multipla skleroza; pandemija COVID-19; cjepiva
• Language: english
• URN:NBN: urn:nbn:hr:105:982346
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-12-22 10:19:48