COVID-19流行期における多発性硬化症・視神経脊髄炎関連疾患・重症筋無力症の治療方針

Treatment of Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorder and Myasthenia Gravis during the COVID-19 Pandemic

多発性硬化症や視神経脊髄炎関連疾患，重症筋無力症では，感染症罹患を契機とした原疾患の悪化がしばしば見られるため，新型コロナウイルス感染症に対しても，感染予防策を徹底する。いずれの疾患においても，疾患自体やそれに対する治療薬による罹患や重症化のリスクの上昇は示されていない。患者ごとの判断が必要だが，治療の中断によって原疾患の増悪や再発を招く可能性があるため，原疾患の治療は継続するのが原則である。

Abstract

Coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has become a global pandemic. Neuroimmunological diseases, such as multiple sclerosis, neuromyelitis optica spectrum disorders, and myasthenia gravis, require long-term immunotherapies having the potential to increase the risk of infection. However, there are no evidence-based guidelines for the management of these disease during the pandemic, despite increasing concerns in patients and neurologists. Currently, there is no evidence of an elevated risk of morbidity and aggravation of COVID-19 in patients with these diseases, irrespective of whether they receive treatment. To prevent relapse or aggravation of the underlying diseases due to COVID-19, all patients should perform general preventive measures, such as social distancing, frequent hand washing, and respiratory hygiene. In patients undergoing immunotherapy, current treatment should be continued to prevent exacerbation of symptoms; however, exceptions to this include high-risk patients for COVID-19, such as the elderly, those with comorbidities including cardiac and respiratory diseases, those taking therapy with immunosuppressive agents, and those with deteriorating symptoms of COVID-19.