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Table 1 Overview of the most frequently applied immunotherapies for neurological diseases and corresponding recommendations regarding their application in times of COVID-19

From: “Neurological manifestations of COVID-19” - guideline of the German society of neurology

Substance Diseases General Recommendation during pandemic Specific recommendations in case of infection
DNA-synthesis Interference strategies
 Azathioprin MG, NMOSD, PACNS, IIM, AIE, Vasculitis, Neurosarcoidosis Continuation Discontinuation
 Methotrexate MG, NMOSD, PACNS, IIM, AIE, Vasculitis, Neurosarcoidosis Continuation Discontinuation
 Cyclophosphamid PACNS, AIE, Vasculitis, Collagene vascular disease Continuation, in case of longterm stable disease de-escalation Discontinuation
 Mitoxantron SPMS Alternative treatments, in case of longterm stable disease: dose-reduction or termination Discontinuation
 Teriflunomid RRMS Continuation Continuation, in case of severe lymphopenia discontinuation
 Mycophenolat-Mofetil MG, NMOSD, PACNS, IIM, Vasculitis, Neurosarcoidosis Continuation Continuation, in case of severe lymphopenia discontinuation
 Cladribin RRMS Delay next treatment cycle Discontinue, look for alternate treatment
Immune cell depletion strategies
 Rituximab MG, NMOSD, PACNS, IIM, AIE, CNS-Vasculitis, CIDP Delay next treatment cycle; CD19-B-Zell-Monitoring Discontinue, look for alternate treatment
 Ocrelizumab RRMS, PPMS Delay next treatment cycle; CD19-B-Zell-Monitoring Discontinue, look for alternate treatment
 Inebilizumab NMOSD Delay next treatment cycle; CD19-B-Zell-Monitoring Discontinue, look for alternate treatment
 Alemtuzumab RRMS Delay next treatment cycle; CD19-B-Zell-Monitoring Discontinue, look for alternate treatment
Leucocyte sequestration
 Fingolimod/Ozanimod RRMS Continuation Continue, or discontinuation for a few weeks
 Siponimod SPMS Continuation Continue, or discontinuation for a few weeks
 Natalizumab RRMS Continuation or delay of treatment cycle Continuation or delay of treatment cycle
Pleiotropic Immunomodulation
 Glatirameracetat RRMS Continuation Continuation
 Dimethylfumarat RRMS Continuation
Severe Lymphopenia: Discontinue 		Continuation
Severe Lymphopenia: Discontinue
Cytokines
 IFN-β RRMS, SPMS Continuation Continuation
 Tocilizumab/Satralizumab NMOSD Continuation Continuation
Complement inhibitors
 Eculizumab MG, NMOSD Continuation Continuation
Intracellular pathway Blockers
 Ciclosporin A MG, IIM Continuation Continuation, dose reduction
Acute therapies
 Steroid pulse therapy MS, MG, NMOSD, PACNS, IIM, AIE, Vasculitis, Neurosarcoidosis Only in case of high disease activity Discontinuation or dose reduction
 Chronic glucosteroid therapy NMOSD, MG, PACNS, IIM, CIDP, Vasculitis, Neurosarcoidosis Dose reduction Stable disease: Dose reduction
 IVIG MG, IIM, CIDP, GBS Continuation or delay of treatment cycle Continuation or delay of treatment cycle
 Plasmapheresis/Immuno-adsorption MS, MG, NMOSD, AIE, IIM, GBS Continuation Continuation
  1. AIE autoimmune encephalitis, GBS Guillain-Barré syndrome, CIDP chronic inflammatory demyelinating polyneuropathy, IFN-ß interferon-beta, IIM idiopathic inflammatory myopathy, IVIG intravenous immunoglobulins, MG myasthenia gravis, MS multiple sclerosis, NMOSD neuromyelitis-optica spectrum disorder, PACNS primary angiitis of the central nervous system, PPMS primary chronic progressive multiple sclerosis, RRMS relapsing-remitting multiple sclerosis, SPMS secondary chronic progressive multiple sclerosis
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