Introduction
SARS-CoV-2 spread rapidly throughout the world causing a global pandemic that put the entire population at risk. There are many people who have a risk of contracting the infection and above all those with pre-existing comorbidities, the elderly or people with therapeutic treatments who can rapidly develop serious damage to the respiratory tract. SARS-CoV-2 infection can be divided into three phases: phase 1, asymptomatic period without hospitalization; phase 2, mild symptomatic period; phase 3, severe symptomatic phase with high viral load and generalized hyperinflammatory state leading to lung damage. A sudden release of cytokines, ”cytokine storm” (CS), characterizes phase 3 and is the most serious. For this reason, having an active immune system is very important in the first phase to fight the virus and in the last two phases to avoid respiratory damage. Treatments with immunomodulating drugs is a very high risk and for this reason patients with multiple sclerosis are more exposed to the possibility of infection. The correct management of the clinical pharmacological aspects associated with MS is of fundamental importance during the pandemic.
MS leads to severe neurological disability if not properly treated. It is an autoimmune disease with demyelinating lesions that cause a wide range of disabling symptoms. Multiple sclerosis is divided into various forms depending on the clinical pathology: benign, relapsing, transactional, predominantly progressive, secondarily progressive, progressive-renewing remission. The disease develops following the immune response against myelin. Multiple sclerosis (MS) exposes to a higher risk of infection (about + 40%) than the general population, reducing the quality of life of patients with serious health risk. Frequent hospitalizations are important for respiratory and urinary tract infections. This is why it can be said that the MS patient is a fragile patient, and in this pandemic period, he must be monitored carefully.
MS treatments are immunomodulating and include first-line drugs such as IFN-beta, glatiramer, dimethyl fumarate, teriflunomide and second-line drugs such as fingolimod, natalizumab, ocrelizumab, alemtuzumab, cladribine. Thanks to these treatments it is possible to control the disease for many years. Observational studies and post-marketing surveillance activities are useful to improve the safety profile of all drugs for MS in the absence of reliable data and studies. It is easy to imagine how drugs that inhibit the immune system can lead to adverse reactions with serious effects and high risk of pandemic infection (1-12).