TY - JOUR T1 - Pulse immunosuppressive therapy for multiple sclerosis during the SARS-CoV-2 lockdown de-escalation plan: safety algorithm JO - Neurología (English Edition) T2 - AU - Valero-López,G. AU - Carreón-Guarnizo,E. AU - Hernández-Clares,R. AU - Iniesta-Martínez,F. AU - Jiménez-Veiga,J. AU - Moreno-Docon,A. AU - Iborra-Bendicho,M.A. AU - Aznar-Robles,E. AU - Hellín-Gil,M.F. AU - Morales-Ortiz,A. AU - Meca-Lallana,J.E. SN - 21735808 M3 - 10.1016/j.nrleng.2020.06.001 DO - 10.1016/j.nrleng.2020.06.001 UR - https://www.elsevier.es/en-revista-neurologia-english-edition--495-articulo-pulse-immunosuppressive-therapy-for-multiple-S2173580820301309 AB - IntroductionThe COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. MethodsWe developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. ResultsWe developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48 h before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24 h before the procedure. ConclusionThe application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT. ER -