Limited data exist on the course of COVID-19 in patients with underlying neuro-inflammatory disorders on immunomodulatory therapies 
Data from the prior SARS and MERS-CoV outbreaks showed no increased risk of adverse outcomes in patients on immunomodulatory therapies [2,3]
Case reports describing SARS-CoV-2 infection in cardiac and renal transplant patients reported that the clinical course and outcomes in these immuncompromised patients mirrored those of immunocompetent patients [4-6]
Therapeutic considerations for COVID-19 include immunomodulatory drugs such as tocilizumab, an interleukin-6 inhibitor, posited to prevent the cytokine storm syndrome described in COVID-19 
Tocilizumab has also successfully been used to treat neuroinflammatory conditions in the pre-COVID-19 era after first-line therapies have failed, including myasthenia gravis and vasculitis [8,9]
CNS Demyelinating Disorders:
For multiple sclerosis patients with active COVID-19, consider holding disease-modifying therapy pending respiratory recovery 
For multiple sclerosis exacerbations, hold corticosteroids in patients who have active COVID-19 and consider holding corticosteroids or arranging home administration of corticosteroids in non-infected patients, as risk of hospitalization for inpatient immunotherapy likely outweighs benefits of earlier recovery
In the absence of active COVID-19:
Glatiramer acetate, teriflunomide, dimethyl fumarate, beta-interferons: not thought to increase the severity of infection and should not be discontinued 
Alemtuzumab, ocrelizumab, cladribine: thought to potentially impede immune response to SARS-CoV-2 infection; consider delaying infusion, as these medications may remain effective for multiple months after administration 
Natalizumab: should not be discontinued given a risk of rebound with severe multiple sclerosis flares 
Fingolimod: can cause reactivation of other viral infections, however, discontinuation carries a risk of rebound flares; benefits of continuing may outweigh risks, though patients being considered for new initiation of fingolimod may benefit from an alternative disease-modifying therapy at this time given the risk 
Patients with evidence of an acute myasthenic flare in the setting of SARS-CoV-2 may benefit from acute treatment with intravenous immunoglobulins (IVIg) or plasmapheresis; IVIg carries a risk of thrombotic events, which may be higher in the setting of an inflammatory response related to COVID-19, however, small case series have demonstrated safe use in this patient population ; see management of neuromuscular respiratory failure here
Azathioprine, mycophenolate mofetil, methotrexate, corticosteroids: continue therapy as normal; benefits in terms of preventing a myasthenic flare likely outweigh any risk of immunosuppression 
Infliximab, rituximab, ocrelizumab: moderately increase the risk of viral infections, so individuals may be more prone to COVID-19 and its complications, however, benefits in terms of preventing a myasthenic flare likely outweigh any risk of immunosuppression; treatment may be delayed in selected cases, though it should not be discontinued altogether 
Tocilizumab, which is currently being used experimentally in the treatment of COVID-19, is likely safe for use in patients with myasthenia gravis; the data on safety of hydroxychloroquine are mixed [9,14].
Azithromycin is being used experimentally in the treatment of COVID-19 ; it has been shown to exacerbate myasthenic symptoms in a handful of published patient case studies and should be avoided in myasthenic patients if possible 
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Stockman LJ, Massoudi MS, Helfand R, et al. Severe acute respiratory syndrome in children. Pediatr. Infect. Dis. J. 2007.
Li F, Cai J, Dong N. First Cases of COVID-19 in Heart Transplantation From China. J. Hear. Lung Transplant. 2020.
Zhu L, Xu X, Ma K, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am. J. Transplant 2020.
Guillen E, Pineiro GJ, Revuelta I, et al. Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation? Am. J. Transplant 2020.
Xu X, Han M, Li T, et al. Effective Treatment of Severe COVID-19 Patients with Tocilizumab. chinaXiv 2020.
Salvarani C, Magnani L, Catanoso M, et al. Tocilizumab: A novel therapy for patients with large-vessel vasculitis. Rheumatology 2012.
Jonsson DI, Pirskanen R, Piehl F. Beneficial effect of tocilizumab in myasthenia gravis refractory to rituximab. Neuromuscul. Disord. 2017.
Jallouli M, Saadoun D, Eymard B, et al. The association of systemic lupus erythematosus and myasthenia gravis: A series of 17 cases, with a special focus on hydroxychloroquine use and a review of the literature. J. Neurol. 2012.
Gautret P, Lagier J-C, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int. J. Antimicrob. Agents 2020.
Gilhus NE, Romi F, Hong Y, Skeie GO. Myasthenia gravis and infectious disease. J. Neurol. 2018.