Beta interferons as immunotherapy in multiple sclerosis: a new outlook on a classic drug during the COVID-19 pandemic.

Beta interferons (IFN-ß) are pleiotropic cytokines with antiviral properties. They play important roles in the pathogenesis of multiple sclerosis (MS), an incurable immune-mediated disorder of the central nervous system. The clinical expression of MS is heterogeneous, with relapses of neuroinflammation and with disability accrual in considerable part unrelated to the attacks. The injectable recombinant IFN-ß preparations are the first approved disease-modifying treatments for MS. They have moderate efficacy in reducing the frequency of relapses, but good long-term cost-efficacy and safety profiles, so are still widely used. They have some tolerability and adherence issues, partly mitigated in recent years by the introduction of a PEGylated formulation and use of 'smart' autoinjector devices. Their general impact on long-term disability is modest but could be further improved by developing accurate tools for identifying the patient profile of best responders to IFN-ß. Here, we present the IFN-ß-based immunomodulatory therapeutic approaches in MS, highlighting their place in the current coronavirus disease (COVID-19) pandemic. The potential role of IFN-ß in the treatment of COVID-19 is also briefly discussed.

Neurological Aspects of the COVID-19 Pandemic

The recent outbreak of the novel coronavirus, SARS-CoV-2 – which causes COVID-19 – has rapidly reached pandemic proportions, causing widespread morbidity and mortality. It has had a major impact on society in general, and in medicine and health in particular. Although primarily a potentially fatal respiratory pathogen, SARS-CoV-2, like other coronaviruses, can be neurotropic. Its receptor, angiotensin-converting enzyme 2 (ACE2), is expressed in endothelial cells in the brain and can be induced in neural cells. COVID-19 is therefore of high relevance to neurological disease. Indeed, various neurological manifestations are increasingly being reported. On the other hand, COVID-19 has a major impact on people with certain neurological diseases. Patients with neuroimmune disorders such as multiple sclerosis or myasthenia gravis who are on immunomodulatory or immunosuppressive treatments may be more susceptible to infection or have a more severe disease due to a blunted immune response. Patients with many neurological disorders may be at risk of severe COVID-19 infection, due to immobility, frailty, disability, diminished respiratory capacity or cognitive dysfunction. Disease-specific patient organisations and neurological societies have been prompt in providing advice and generating guidelines for various neurological conditions. Local, national and international registers are being created and will be essential in monitoring the disease and its outcomes. New knowledge about COVID-19, including issues of relevance to neurology, is generated daily. This review presents some succinct background information on coronaviruses and its neuro-invasive potential, the current knowledge of neurological manifestations, and the impact of COVID-19 on individuals with neurological disease. Some disease-specific recommendations are briefly listed or referenced.