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Perdaens O, van Pesch V. Molecular Mechanisms of Immunosenescene and Inflammaging: Relevance to the Immunopathogenesis and Treatment of Multiple Sclerosis. Front Neurol 2022; 12:811518. [PMID: 35281989 PMCID: PMC8913495 DOI: 10.3389/fneur.2021.811518] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/27/2021] [Indexed: 12/18/2022] Open
Abstract
Aging is characterized, amongst other features, by a complex process of cellular senescence involving both innate and adaptive immunity, called immunosenescence and associated to inflammaging, a low-grade chronic inflammation. Both processes fuel each other and partially explain increasing incidence of cancers, infections, age-related autoimmunity, and vascular disease as well as a reduced response to vaccination. Multiple sclerosis (MS) is a lifelong disease, for which considerable progress in disease-modifying therapies (DMTs) and management has improved long-term survival. However, disability progression, increasing with age and disease duration, remains. Neurologists are now involved in caring for elderly MS patients, with increasing comorbidities. Aging of the immune system therefore has relevant implications for MS pathogenesis, response to DMTs and the risks mediated by these treatments. We propose to review current evidence regarding markers and molecular mechanisms of immunosenescence and their relevance to understanding MS pathogenesis. We will focus on age-related changes in the innate and adaptive immune system in MS and other auto-immune diseases, such as systemic lupus erythematosus and rheumatoid arthritis. The consequences of these immune changes on MS pathology, in interaction with the intrinsic aging process of central nervous system resident cells will be discussed. Finally, the impact of immunosenescence on disease evolution and on the safety and efficacy of current DMTs will be presented.
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Affiliation(s)
- Océane Perdaens
- Laboratory of Neurochemistry, Institute of Neuroscience, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Vincent van Pesch
- Laboratory of Neurochemistry, Institute of Neuroscience, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Department of Neurology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- *Correspondence: Vincent van Pesch
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Cannabinoid and endocannabinoid system: a promising therapeutic intervention for multiple sclerosis. Mol Biol Rep 2022; 49:5117-5131. [PMID: 35182322 DOI: 10.1007/s11033-022-07223-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/02/2022] [Indexed: 02/06/2023]
Abstract
Multiple sclerosis (MS) is a chronic and complex neurodegenerative disease, distinguished by the presence of lesions in the central nervous system (CNS) due to exacerbated immunological responses that inflict oligodendrocytes and the myelin sheath of axons. In recent years, studies have focused on targeted therapeutics for MS that emphasize the role of G protein-coupled receptors (GPCRs), specifically cannabinoids receptors. Clinical studies have suggested the therapeutic potential of cannabinoids derived from Cannabis sativa in relieving pain, tremors and spasticity. Cannabinoids also appear to prevent exaggerated immune responses in CNS due to compromised blood-brain barrier. Both, endocannabinoid system (ECS) modulators and cannabinoid ligands actively promote oligodendrocyte survival by regulating signaling, migration and myelination of nerve cells. The cannabinoid receptors 1 (CB1) and 2 (CB2) of ECS are the main ones in focus for therapeutic intervention of MS. Various CB1/CB2 receptors agonists have been experimentally studied which showed anti-inflammatory properties and are considered to be effective as potential therapeutics for MS. In this review, we focused on the exacerbated immune attack on nerve cells and the role of the cannabinoids and its interaction with the ECS in CNS during MS pathology.
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Schiavetti I, Ponzano M, Signori A, Bovis F, Carmisciano L, Sormani MP. Severe outcomes of COVID-19 among patients with multiple sclerosis under anti-CD-20 therapies: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 57:103358. [PMID: 35158467 PMCID: PMC8570399 DOI: 10.1016/j.msard.2021.103358] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 02/06/2023]
Abstract
Background COVID-19 may spread through various ways ranging from asymptomatic to severe forms, until respiratory failure, critical conditions and death occurs. There is a particular concern for patients affected by multiple sclerosis, especially for those under disease-modifying treatments. Some studies have found an association between anti-CD20 therapies (especially rituximab) and severe COVID-19. However, results were not always clear and thus a systematic review was helpful. Methods A systematic literature search was performed independently by two authors on the main search tools considering as key inclusion criterion the presence of data on patients under ocrelizumab or rituximab positive to COVID-19. The quality of the included studies was evaluated based on a modified version of the Dutch Cochrane center critical review checklist proposed by MOOSE and in case of missing data an email was sent to the corresponding authors asking for missing information. After excluding case-reports, a random effects meta-analysis of proportions was conducted using the continuity correction and the I2statistic was calculated to measure heterogeneity. Results 29 articles were included in the analysis and the median quality of the articles reached 4/5 after having integrated the additional details provided by the authors. The articles included 5173 patients, of whom 770 (14.8%) and 455 (8.8%) were, respectively, under ocrelizumab and rituximab. Pooled estimates of hospitalization, pneumonia and intensive care unit admission were 18.1%, 14.8% and 3.3%, respectively, while pooled estimate for death was 1.8% overall and 1.6% and 4.5%, respectively, for patients under ocrelizumab and rituximab. Conclusion Patients treated with rituximab seem to be at higher risk of severe COVID-19 outcomes compared to patients under other treatments.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy.
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Francesca Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Patti F, Chisari CG, Toscano S, Arena S, Finocchiaro C, Cimino V, Milone G. Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis Patients: Monocentric Case Series and Systematic Review of the Literature. J Clin Med 2022; 11:jcm11040942. [PMID: 35207216 PMCID: PMC8875789 DOI: 10.3390/jcm11040942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/05/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory and immune-mediated disease of the central nervous system (CNS), commonly affecting young adults and potentially associated with life-long disability. About 14 disease-modifying treatments (DMTs) are currently approved for the treatment of MS. However, despite the use of highly effective therapies, some patients exhibit a highly active disease with an aggressive course from onset and a higher risk of long-term disability accrual. In the last few years, several retrospective studies, clinical trials, meta-analyses and systematic reviews have investigated autologous hematopoietic stem cell transplantation (AHSCT) as a possible therapeutic option in order to address this unmet clinical need. These studies demonstrated that AHSCT is a highly efficacious and relatively safe therapeutic option for the treatment of highly active MS. Particularly, over recent years, the amount of evidence has grown, with significant improvements in the development of patient selection criteria, choice of the most suitable transplant technique and clinical experience. In this paper, we present six patients who received AHSCT in our MS center and we systematically reviewed recent evidence about the long-term efficacy and safety of AHSCT and the placement of AHSCT in the rapidly evolving therapeutic armamentarium for MS.
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Affiliation(s)
- Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
- Correspondence: (F.P.); (C.G.C.); Tel.: +39-09-5378-2620 (F.P.)
| | - Clara Grazia Chisari
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
- Correspondence: (F.P.); (C.G.C.); Tel.: +39-09-5378-2620 (F.P.)
| | - Simona Toscano
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
| | - Sebastiano Arena
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
| | - Chiara Finocchiaro
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95125 Catania, Italy; (S.T.); (S.A.); (C.F.)
| | - Vincenzo Cimino
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy;
| | - Giuseppe Milone
- Hematology and Bone Marrow Transplant Unit, Azienda Policlinico-Vittorio Emanuele, 95124 Catania, Italy;
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Golshani M, Hrdý J. Multiple Sclerosis Patients and Disease Modifying Therapies: Impact on Immune Responses against COVID-19 and SARS-CoV-2 Vaccination. Vaccines (Basel) 2022; 10:vaccines10020279. [PMID: 35214735 PMCID: PMC8876554 DOI: 10.3390/vaccines10020279] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
This article reviews the literature on SARS-CoV-2 pandemic and multiple sclerosis (MS). The first part of the paper focuses on the current data on immunopathology of SARS-CoV-2 and leading vaccines produced against COVID-19 infection. In the second part of the article, we discuss the effect of Disease Modifying Therapies (DMTs) on COVID-19 infection severity or SARS-CoV-2 vaccination in MS patients plus safety profile of different vaccine platforms in MS patients.
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Affiliation(s)
| | - Jiří Hrdý
- Correspondence: ; Tel.: +420-224968509
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Dalla Costa G, Leocani L, Comi G. Ofatumumab subcutaneous injection for the treatment of relapsing forms of multiple sclerosis. Expert Rev Clin Immunol 2022; 18:105-114. [PMID: 35107057 DOI: 10.1080/1744666x.2022.2031982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In recent years, different studies have highlighted the importance of B cells in the pathophysiology of multiple sclerosis (MS): they secrete cytokines to modulate the inflammatory environment, present antigens for the activation of T lymphocytes, and they secrete antibodies contributing to the destruction of the myelin sheath. Combined, these findings have lead to new possible means for treating MS. AREAS COVERED In this review, we provide an up-to-date overview of the characteristics of ofatumumab (aka Kesimpta), and the differences between this drug and the other anti-CD20 monoclonal antibodies used to treat MS. EXPERT OPINION The evolution of disease-modifying treatment algorithms in MS underlines the importance of starting treatment as soon as the diagnosis is defined, and with adequate "treatment intensity". Monoclonal antibodies and other aggressive treatments are now considered as an option at the clinical presentation of the disease, based to the prognostic profile emerging through clinical and paraclinical investigations. The recent adoption of new diagnostic criteria allows for the early diagnosis of MS. This, together with the availability of disease-modifying therapies (DMTs), such as ofatumumab, with a good efficacy/safety profile and which are easy to administer, could contribute to significant improvements in the long-term prognosis of MS.
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Affiliation(s)
- G Dalla Costa
- Institute of Experimental Neurophysiology of San Raffaele Hospital, via Olgettina 60, Milan, Italy.,Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy
| | - L Leocani
- Institute of Experimental Neurophysiology of San Raffaele Hospital, via Olgettina 60, Milan, Italy.,Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy
| | - G Comi
- Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy.,Casa di Cura Privata del Policlinico, via Dezza 48, Milan, Italy
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Tortorella C, Aiello A, Gasperini C, Agrati C, Castilletti C, Ruggieri S, Meschi S, Matusali G, Colavita F, Farroni C, Cuzzi G, Cimini E, Tartaglia E, Vanini V, Prosperini L, Haggiag S, Galgani S, Quartuccio ME, Salmi A, Repele F, Altera AMG, Cristofanelli F, D'Abramo A, Bevilacqua N, Corpolongo A, Puro V, Vaia F, Capobianchi MR, Ippolito G, Nicastri E, Goletti D. Humoral- and T-Cell-Specific Immune Responses to SARS-CoV-2 mRNA Vaccination in Patients With MS Using Different Disease-Modifying Therapies. Neurology 2022; 98:e541-e554. [PMID: 34810244 PMCID: PMC8826460 DOI: 10.1212/wnl.0000000000013108] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/04/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the immune-specific response after full severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination of patients with multiple sclerosis (MS) treated with different disease-modifying drugs by the detection of both serologic and T-cell responses. METHODS Healthcare workers (HCWs) and patients with MS, having completed the 2-dose schedule of an mRNA-based vaccine against SARS-CoV-2 in the past 2-4 weeks, were enrolled from 2 parallel prospective studies conducted in Rome, Italy, at the National Institute for Infectious diseases Spallanzani-IRCSS and San Camillo Forlanini Hospital. Serologic response was evaluated by quantifying the region-binding domain (RBD) and neutralizing antibodies. Cell-mediated response was analyzed by a whole-blood test quantifying interferon (IFN)-γ response to spike peptides. Cells responding to spike stimulation were identified by fluorescence-activated cell sorting analysis. RESULTS We prospectively enrolled 186 vaccinated individuals: 78 HCWs and 108 patients with MS. Twenty-eight patients with MS were treated with IFN-β, 35 with fingolimod, 20 with cladribine, and 25 with ocrelizumab. A lower anti-RBD antibody response rate was found in patients treated with ocrelizumab (40%, p < 0.0001) and fingolimod (85.7%, p = 0.0023) compared to HCWs and patients treated with cladribine or IFN-β. Anti-RBD antibody median titer was lower in patients treated with ocrelizumab (p < 0.0001), fingolimod (p < 0.0001), and cladribine (p = 0.010) compared to HCWs and IFN-β-treated patients. Serum neutralizing activity was present in all the HCWs tested and in only a minority of the fingolimod-treated patients (16.6%). T-cell-specific response was detected in the majority of patients with MS (62%), albeit with significantly lower IFN-γ levels compared to HCWs. The lowest frequency of T-cell response was found in fingolimod-treated patients (14.3%). T-cell-specific response correlated with lymphocyte count and anti-RBD antibody titer (ρ = 0.554, p < 0.0001 and ρ = 0.255, p = 0.0078 respectively). IFN-γ T-cell response was mediated by both CD4+ and CD8+ T cells. DISCUSSION mRNA vaccines induce both humoral and cell-mediated specific immune responses against spike peptides in all HCWs and in the majority of patients with MS. These results carry relevant implications for managing vaccinations, suggesting promoting vaccination in all treated patients with MS. CLASSIFICATION OF EVIDENCE This study provides Class III data that SARS-CoV-2 mRNA vaccination induces both humoral and cell-mediated specific immune responses against viral spike proteins in a majority of patients with MS.
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Affiliation(s)
- Carla Tortorella
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Alessandra Aiello
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Claudio Gasperini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Chiara Agrati
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Concetta Castilletti
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Serena Ruggieri
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Silvia Meschi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Giulia Matusali
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Francesca Colavita
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Chiara Farroni
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Gilda Cuzzi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Eleonora Cimini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Eleonora Tartaglia
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Valentina Vanini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Luca Prosperini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Shalom Haggiag
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Simona Galgani
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Maria Esmeralda Quartuccio
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Andrea Salmi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Federica Repele
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Anna Maria Gerarda Altera
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Flavia Cristofanelli
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Alessandra D'Abramo
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Nazario Bevilacqua
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Angela Corpolongo
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Vincenzo Puro
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Francesco Vaia
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Maria Rosaria Capobianchi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Giuseppe Ippolito
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Emanuele Nicastri
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Delia Goletti
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy.
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Sainzde la Maza S, Muñoz JS, Pilode la Fuente B, Thuissard I, Andreu‑Vázquez C, Sánchez-Seco VG, Salgado-Cámara P, Costa-Frossard L, Monreal E, Ayuso-Peralta L, García-Vasco L, García‑Domínguez JM, Martínez-Ginés ML, Fernández CM, Díaz-Díaz J, Oreja-Guevara C, Gómez‑Moreno M, Martín H, Rubio-Flores L, Blasco MR, Villar-Guimerans LM, Aladro Y. Early predictive risk factors for dimethyl fumarate-associated lymphopenia in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 59:103669. [DOI: 10.1016/j.msard.2022.103669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/16/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
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Cheng XD, Ma JY, Cruz J, Jin J, Peng XY, Zhang AM. Therapeutics of integrative medicine ameliorate immunological disorders of the nervous system: A meta-analysis. WORLD JOURNAL OF TRADITIONAL CHINESE MEDICINE 2022. [DOI: 10.4103/2311-8571.336837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cheng XD, Ma JY, Cruz J, Jin J, Peng XY, Zhang AM. Therapeutics of integrative medicine ameliorate immunological disorders of the nervous system: A meta-analysis. WORLD JOURNAL OF TRADITIONAL CHINESE MEDICINE 2022. [DOI: 10.4103/wjtcm.wjtcm_57_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Louapre C, Ibrahim M, Maillart E, Abdi B, Papeix C, Stankoff B, Dubessy AL, Bensa-Koscher C, Créange A, Chamekh Z, Lubetzki C, Marcelin AG, Corvol JC, Pourcher V. Anti-CD20 therapies decrease humoral immune response to SARS-CoV-2 in patients with multiple sclerosis or neuromyelitis optica spectrum disorders. J Neurol Neurosurg Psychiatry 2022; 93:24-31. [PMID: 34341142 PMCID: PMC8331322 DOI: 10.1136/jnnp-2021-326904] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND SARS-CoV-2 seroconversion rate after COVID-19 may be influenced by disease-modifying therapies (DMTs) in patients with multiple sclerosis (MS) or neuromyelitis optica spectrum disorders (NMO-SD). OBJECTIVE To investigate the seroprevalence and the quantity of SARS-CoV-2 antibodies in a cohort of patients with MS or NMO-SD. METHODS Blood samples were collected in patients diagnosed with COVID-19 between 19 February 2020 and 26 February 2021. SARS-CoV-2 antibody positivity rates and Ig levels (anti-S IgG titre, anti-S IgA index, anti-N IgG index) were compared between DMTs groups. Multivariate logistic and linear regression models were used to estimate the influence of DMTs and other confounding variables on SARS-CoV-2 serological outcomes. RESULTS 119 patients (115 MS, 4 NMO, mean age: 43.0 years) were analysed. Overall, seroconversion rate was 80.6% within 5.0 (SD 3.4) months after infection. 20/21 (95.2%) patients without DMT and 66/77 (85.7%) patients on DMTs other than anti-CD20 had at least one SARS-CoV-2 Ig positivity, while this rate decreased to only 10/21 (47.6%) for patients on anti-CD20 (p<0.001). Being on anti-CD20 was associated with a decreased odd of positive serology (OR, 0.07 (95% CI 0.01 to 0.69), p=0.02) independently from time to COVID-19, total IgG level, age, sex and COVID-19 severity. Time between last anti-CD20 infusion and COVID-19 was longer (mean (SD), 3.7 (2.0) months) in seropositive patients compared with seronegative patients (mean (SD), 1.9 (1.5) months, p=0.04). CONCLUSIONS SARS-CoV-2 antibody response was decreased in patients with MS or NMO-SD treated with anti-CD20 therapies. Monitoring long-term risk of reinfection and specific vaccination strategies in this population may be warranted. TRIAL REGISTRATION NUMBER NCT04568707.
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Affiliation(s)
- Céline Louapre
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, CIC neurosciences, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Michella Ibrahim
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, CIC neurosciences, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Elisabeth Maillart
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, CIC neurosciences, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Basma Abdi
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique Hôpitaux de Paris, Laboratoire de virologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Caroline Papeix
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, CIC neurosciences, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Bruno Stankoff
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Department of Neurology, Saint Antoine Hospital, Paris, France
| | - Anne-Laure Dubessy
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Department of Neurology, Saint Antoine Hospital, Paris, France
| | - Caroline Bensa-Koscher
- Department of Neurology, The Fondation Adolphe de Rothschild Hospital, Paris, Île-de-France, France
| | - Alain Créange
- UPEC University, Groupe Hospitalier Henri Mondor, Service de Neurologie and CRC SEP, Assistance Publique-Hopitaux de Paris, Créteil, Île-de-France, France
| | - Zina Chamekh
- Hôpital de la Pitié-Salpêtrière, Biochemistry Department, Assistance Publique Hôpitaux de Paris, Paris, Île-de-France, France
| | - Catherine Lubetzki
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, CIC neurosciences, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique Hôpitaux de Paris, Laboratoire de virologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne University, Paris Brain Institute - ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, CIC neurosciences, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Valérie Pourcher
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique Hôpitaux de Paris, Service de Maladies Infectieuses, Hôpital de la Pitié-Salpêtrière, Paris, France
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Lymphocyte Counts and Multiple Sclerosis Therapeutics: Between Mechanisms of Action and Treatment-Limiting Side Effects. Cells 2021; 10:cells10113177. [PMID: 34831400 PMCID: PMC8625745 DOI: 10.3390/cells10113177] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 01/18/2023] Open
Abstract
Although the detailed pathogenesis of multiple sclerosis (MS) is not completely understood, a broad range of disease-modifying therapies (DMTs) are available. A common side effect of nearly every MS therapeutic agent is lymphopenia, which can be both beneficial and, in some cases, treatment-limiting. A sound knowledge of the underlying mechanism of action of the selected agent is required in order to understand treatment-associated changes in white blood cell counts, as well as monitoring consequences. This review is a comprehensive summary of the currently available DMTs with regard to their effects on lymphocyte count. In the first part, we describe important general information about the role of lymphocytes in the course of MS and the essentials of lymphopenic states. In the second part, we introduce the different DMTs according to their underlying mechanism of action, summarizing recommendations for lymphocyte monitoring and definitions of lymphocyte thresholds for different therapeutic regimens.
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Heidler F, Baldt J, Frahm N, Langhorst SE, Mashhadiakbar P, Streckenbach B, Zettl UK, Richter J. Vaccination Setting of Patients with Autoimmune Diseases in Times of Severe Acute Respiratory Syndrome Coronavirus Type 2 Pandemic Using the Example of Multiple Sclerosis Patients: A Longitudinal Multicenter Study. Eur Neurol 2021; 85:104-111. [PMID: 34743082 DOI: 10.1159/000519582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection represents a serious health risk, especially in chronically ill people. Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disease. Vaccinations play an important role in the therapeutic MS management. This study aimed at determining MS patients' attitudes toward vaccinations and governmental measures before and during the SARS-CoV-2 pandemic, including associations with sociodemographic and clinical variables. METHODS In a longitudinal, multicenter study, 200 MS patients were investigated regarding their vaccination attitudes before and after the first wave of the SARS-CoV-2 pandemic. Data on vaccination status and burden (physical, psychological, and social) experienced as caused by the pandemic and related governmental safety measures were registered. RESULTS Patients with progressive MS felt significantly more pandemic-burdened than patients with relapsing-onset MS (p < 0.001). Older patients were more frequently willing to get vaccinated against SARS-CoV-2 than younger patients (p < 0.001). After the first pandemic wave, patients with pre-pandemic willingness to comply with vaccination recommendations were more likely to accept recommended standard vaccinations (60% vs. 36%) and a possible SARS-CoV-2 vaccination than pre-pandemic nonwilling patients (66.7% vs. 42.0%). CONCLUSIONS The vaccination topic was not immediately present in many patients before the pandemic. MS patients need comprehensive and understandable education meeting their concerns using evidence-based and convincing arguments on the subject of vaccination, particularly younger patients. Older patients are already more often willing to become vaccinated. Complete vaccination status is necessary to avoid multiple infections.
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Affiliation(s)
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, University Medical Center of Rostock, Rostock, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, University Medical Center of Rostock, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, University Medical Center of Rostock, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, University Medical Center of Rostock, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, University Medical Center of Rostock, Rostock, Germany
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, University Medical Center of Rostock, Rostock, Germany
| | - Jörg Richter
- Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany.,Faculty of Health Sciences, University of Hull, Hull, United Kingdom
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64
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Gold R, Fätkenheuer G, Hartung HP, Kleinschnitz C, Marks R, Maschke M, Bayas A, Löbermann M, Zettl UK, Wiendl H. Vaccination in multiple sclerosis patients treated with highly effective disease-modifying drugs: an overview with consideration of cladribine tablets. Ther Adv Neurol Disord 2021; 14:17562864211019598. [PMID: 34671422 PMCID: PMC8521756 DOI: 10.1177/17562864211019598] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
Infectious diseases are an important consideration in autoimmune conditions such as multiple sclerosis. Infective episodes may trigger relapses and significantly deteriorate the course of the disease. Some immunotherapies may cause increased rates of infection-related adverse events. Thus, infection and vaccine-related issues should be included in the individualized patient-specific treatment strategy and counseling before starting therapy and regularly on treatment. Clinical and epidemiological studies as well as pharmacovigilance data repeatedly demonstrated the safety of the great majority of vaccines in multiple sclerosis patients. Moreover, studies have shown that vaccinations with killed/inactivated vaccines do not increase the short-term risk of relapse or deterioration in multiple sclerosis, whereas infections have been shown to provoke relapses. The available evidence indicates reduced humoral vaccination efficacy on treatment with MS drugs acting on the S1P receptor, natalizumab, and B-cell depleting therapies. Recent data for cladribine tablets suggest the potential of effective immunization in the interval of the two treatment courses and after completion of therapy. Regardless of treatment, vaccine efficacy may be optimized with proper timing of application. Multiple sclerosis patients receiving highly effective therapies should be vaccinated according to general recommendations for healthy adults. Immunization against COVID-19 is highly recommended for all multiple sclerosis patients regardless of age and comorbidities. Preliminary data show the potential of adequate responses in patients treated with cladribine tablets.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, Bochum, Germany
| | - Gerd Fätkenheuer
- Department of Clinical Infectiology, University Hospital of Cologne, Cologne, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany Brain and Mind Centre, University of Sydney, Australia
| | | | - Reinhard Marks
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center-University of Freiburg, Germany
| | - Matthias Maschke
- Department of Neurology, Krankenhaus der Barmherzigen Brueder, Campus Trier, University of Mainz, Germany
| | - Antonios Bayas
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Micha Löbermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, Rostock University Medical Center, Rostock, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunology Section, University of Rostock, Rostock, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
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65
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Cajamarca-Baron J, Guavita-Navarro D, Buitrago-Bohorquez J, Gallego-Cardona L, Navas A, Cubides H, Arredondo AM, Escobar A, Rojas-Villarraga A. [SARS-CoV-2 (COVID-19) in Patients with some Degree of Immunosuppression]. ACTA ACUST UNITED AC 2021; 17:408-419. [PMID: 34630575 PMCID: PMC7486041 DOI: 10.1016/j.reuma.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023]
Abstract
Antecedentes No es claro si los pacientes con algún grado de inmunosupresión tienen peores desenlaces en la infección por SARS-CoV-2, en comparación con la población sana. Objetivo Realizar una revisión narrativa de la información disponible sobre infección por SARS-CoV-2 en pacientes inmunosuprimidos, especialmente pacientes con cáncer, trasplantados, con patologías neurológicas, inmunodeficiencias primarias y secundarias. Resultados Los pacientes con cáncer y tratamiento reciente del mismo (quimioterapia o cirugía) e infección por SARS-CoV-2 tienen mayor riesgo de peores desenlaces. En los pacientes trasplantados (renal, cardiaco y hepático), con patologías neurológicas (esclerosis múltiple [EM], neuromielitis óptica [NMODS], miastenia grave [MG]), inmunodeficiencias primarias e infección por virus de inmunodeficiencia humana (VIH) en asociación con uso de inmunosupresores, los estudios no han mostrado tendencia a peores desenlaces. Conclusión Dada la poca evidencia con que contamos hasta el momento no es claro el comportamiento de la infección por SARS-CoV-2 en pacientes con inmunosupresión, pero los estudios actuales no han mostrado peores desenlaces en este tipo de pacientes, a excepción de los pacientes con cáncer.
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Affiliation(s)
- Jairo Cajamarca-Baron
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | - Diana Guavita-Navarro
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | | | - Laura Gallego-Cardona
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | - Angela Navas
- Servicio de Neurología, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | - Hector Cubides
- Servicio de Reumatología, Hospital San José, Bogotá, Colombia
| | | | | | - Adriana Rojas-Villarraga
- Servicio de Reumatología, Instituto de Investigaciones, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
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Zakaria M, Ponzano M, Schiavetti I, Carmisciano L, Nada M, AbdelNaseer M, Zamzam D, Masoud J, Aref H, Shalaby N, AbdelNaser A, Hamdy S, Saad M, Shehata H, Aly M, Kishk N, Hamdy E, Hassan A, Hashish A, Ahmed S, Foad M, Sormani MP. The MuSC-19 study: The Egyptian cohort. Mult Scler Relat Disord 2021; 56:103324. [PMID: 34656933 PMCID: PMC8522261 DOI: 10.1016/j.msard.2021.103324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to report the severity of COVID-19 in a cohort of Egyptian patients with multiple sclerosis (MS) with particular attention on the impact of disease modifying drugs (DMDs). METHODS AND STUDY POPULATION We included 119 MS patients recruited from two centers, Ain-Shams university and Cairo university with confirmed or suspected COVID-19 during the period from May to September 2020 as a part of the MuSC-19 project. Univariate logistic regression was fitted to assess risk factors for severe COVID-19 (at least one outcome among hospitalization, ICU admission and death). RESULTS Females were 77%, mean age was 34 years, mean duration of MS was 5.28 years, median EDSS was 3, most of the patients (83%) had RRMS, while 15% and 2% had respectively SPMS and PPMS. Only eleven patients (9% of study population) had a severe outcome and 3 patients (3%) died. Headache was the only symptom significantly associated with the severity of COVID-19 (OR=10.85, P = 0.001). There was no association between any of the DMDs and severe COVID-19 outcome. CONCLUSION This study showed an acceptable safety profile of DMDs in Egyptian MS patients who developed COVID-19, as 91% of the cohort had a favorable outcome. Headache as a symptom associated with severe outcome in Egyptian patients' needs further validation.
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Affiliation(s)
- Magd Zakaria
- Neurology Department, Ain Shams University, Egypt.
| | - Marta Ponzano
- Department 0f Health Sciences, University of Genova, Italy
| | | | | | - Mona Nada
- Neurology Department, Cairo University, Egypt
| | | | - Dina Zamzam
- Neurology Department, Ain Shams University, Egypt
| | - Janet Masoud
- Neurology Department, Sheikh Zayed Hospital, Ministry of Health, Egypt
| | - Hany Aref
- Neurology Department, Ain Shams University, Egypt
| | | | | | | | - Mahmoud Saad
- Neurology Department, Ain Shams University, Egypt
| | | | - Mohamed Aly
- Neurology Department, Ain Shams University, Egypt
| | | | - Eman Hamdy
- Neurology Department, Alexandria University, Egypt
| | - Amr Hassan
- Neurology Department, Cairo University, Egypt
| | - Ahmed Hashish
- Neurology Department, Mansoura New General Hospital, Egypt
| | | | - Mohamed Foad
- Neurology Department, Ain Shams University, Egypt
| | - Maria Pia Sormani
- Department 0f Health Sciences, University of Genova, Italy; IRCCS Ospedale Policlinico, San Martino, Genoa, Italy
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Monschein T, Hartung HP, Zrzavy T, Barnett M, Boxberger N, Berger T, Chataway J, Bar-Or A, Rommer PS, Zettl UK. Vaccination and multiple sclerosis in the era of the COVID-19 pandemic. J Neurol Neurosurg Psychiatry 2021; 92:1033-1043. [PMID: 34353858 PMCID: PMC8458056 DOI: 10.1136/jnnp-2021-326839] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/16/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Tobias Monschein
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hans-Peter Hartung
- Department of Neurology, Medical University of Vienna, Vienna, Austria .,Department of Neurology, Universitätsklinikum Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nina Boxberger
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jeremy Chataway
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Amit Bar-Or
- Department of Neurology, Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paulus Stefan Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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68
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Gebhardt M, Kropp P, Hoffmann F, Zettl UK. Headache in multiple sclerosis - pharmacological aspects. Curr Pharm Des 2021; 28:445-453. [PMID: 34551691 DOI: 10.2174/1381612827666210922114100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/19/2021] [Indexed: 12/11/2022]
Abstract
For decades, headache was not considered a typical symptom of multiple sclerosis (MS) and was construed as a "red flag" for important differential diagnoses such as cerebral vasculitis. Meanwhile, several studies have demonstrated an increased prevalence of headache in MS compared to the general population. This is due to the heterogeneity of headache genesis with frequent occurrence of both primary and secondary headaches in MS. On the one hand, MS and migraine are often comorbid. On the other hand, secondary headaches occur frequently, especially in the course of MS relapses. These are often migraine-like headaches caused by inflammation, which can improve as a result of MS-specific therapy. Headaches are particularly common in the early stages of chronic inflammatory CNS disease, where inflammatory activity is greatest. In addition, headache can also occur as a side effect of disease-modifying drugs (DMDs). Headache can occur with most DMDs and is most frequently described with interferon-beta therapy. The aim of this work is to present the prevalence of headache and describe the heterogeneity of possible causes of headache in MS. In addition, important therapeutic aspects in the treatment of MS patients in general will be presented as well as different approaches to the treatment of headache in MS depending on the etiological classification.
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Affiliation(s)
- Marcel Gebhardt
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Neurologie, Röntgenstraße 1, 06120 Halle. Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock. Germany
| | | | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock. Germany
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69
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Yang G, Van Kaer L. Therapeutic Targeting of Immune Cell Autophagy in Multiple Sclerosis: Russian Roulette or Silver Bullet? Front Immunol 2021; 12:724108. [PMID: 34531871 PMCID: PMC8438236 DOI: 10.3389/fimmu.2021.724108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) in which the immune system damages the protective insulation surrounding nerve fibers that project from neurons. The pathological hallmark of MS is multiple areas of myelin loss accompanied by inflammation within the CNS, resulting in loss of cognitive function that ultimately leads to paralysis. Recent studies in MS have focused on autophagy, a cellular self-eating process, as a potential target for MS treatment. Here, we review the contribution of immune cell autophagy to the pathogenesis of experimental autoimmune encephalomyelitis (EAE), the prototypic animal model of MS. A better understanding of the role of autophagy in different immune cells to EAE might inform the development of novel therapeutic approaches in MS and other autoimmune and inflammatory diseases.
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Affiliation(s)
- Guan Yang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Luc Van Kaer
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
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70
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Ferro D, Prista-Leão B, Costa A, Silva-Pinto A, Abreu C, Sá MJ. Infectious Risk Mitigation in Patients with Multiple Sclerosis under Disease-Modifying Therapies - the Experience of a Collaborative Neurology-Infectious Diseases Approach. J Cent Nerv Syst Dis 2021; 13:11795735211042188. [PMID: 34526834 PMCID: PMC8436289 DOI: 10.1177/11795735211042188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple sclerosis treatment has changed in the last years with the emergence of new disease-modifying therapies (DMTs). Despite a better efficacy profile, these drugs raise concerns about infectious risk, which needs to be mitigated. OBJECTIVE To analyze the results of a systematic collaborative approach between Neurology and Infectious Diseases (ID) Departments in the management of infectious risk and complications in MS patients treated with DMT. METHODS Retrospective collection of MS patients' demographic and clinical data from clinical records of MS and ID outpatient clinics (2011-2017). RESULTS We included 149 patients: most had evidence of previous contact with Herpesviridae, and half of them were not immune to hepatitis A and B viruses (HAV and HBV). Vaccines for HAV, HBV, and Streptococcus pneumoniae were administered in 91%, 78%, and 88% of non-immune patients, respectively. JC virus serology monitoring prevented natalizumab (NTZ) initiation or prompted its switch in 34/122 patients. Forty patients had latent tuberculosis, in which 88% were treated. Infectious events occurred in 33 patients, mostly mild urinary, respiratory, and herpes virus group infections. Only three patients required inpatient care. CONCLUSION Facing the expansion of the new DMT, we highlight the benefits of an interdisciplinary approach for safer use of the chosen treatment.
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Affiliation(s)
- Daniela Ferro
- MS Clinic, Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Beatriz Prista-Leão
- Faculty of Medicine of University of Porto, Porto, Portugal
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Andreia Costa
- MS Clinic, Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - André Silva-Pinto
- Faculty of Medicine of University of Porto, Porto, Portugal
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cândida Abreu
- Faculty of Medicine of University of Porto, Porto, Portugal
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria José Sá
- MS Clinic, Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- FP-ENAS (UFP Energy, Environment and Health Research Unit), University Fernando Pessoa, Porto, Portugal
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Miller AE. An updated review of teriflunomide's use in multiple sclerosis. Neurodegener Dis Manag 2021; 11:387-409. [PMID: 34486382 DOI: 10.2217/nmt-2021-0014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Teriflunomide, a once daily, oral disease-modifying therapy, has demonstrated consistent efficacy, safety and tolerability in patients with relapsing forms of multiple sclerosis (MS) and with a first clinical episode suggestive of MS treated up to 12 years. This review is an update to a previous version that examined data from the teriflunomide core clinical development program and extension studies. Data have since become available from active comparator trials with other disease-modifying therapies, treatment-related changes in brain volume (analyzed using structural image evaluation using normalization of atrophy) and real-world evidence including patient-reported outcomes. Initial data on the potential antiviral effects of teriflunomide in patients with MS, including case reports of patients infected with the 2019 novel coronavirus (SARS-CoV-2), are also presented.
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Affiliation(s)
- Aaron E Miller
- Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
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72
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Boyko AN, Sivertseva SA, Chemakina DS, Spirin NN, Bykova OV, Guseva ME. [Vaccination and multiple sclerosis at the present stage]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:44-48. [PMID: 34387445 DOI: 10.17116/jnevro202112107244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Immunization of the patients with autoimmune diseases is rising a lot of concerns. It was previously demonstrated that vaccination in MS patients was not associated with an increased risk of exacerbations. A personalized approach is needed to define the immunization schedule. A decision should be made based on the course of the disease and the treatment used. Multiple sclerosis is not an absolute contraindication to vaccination. Any authorized vaccine can be used in MS patients.
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Affiliation(s)
- A N Boyko
- Pirogov Russian National Research University, Moscow, Russia.,Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - S A Sivertseva
- Tyumen Regional Center for Multiple Sclerosis, AO MSCH «Neftyanik», Tyumen, Russia
| | - D S Chemakina
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - N N Spirin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - O V Bykova
- Research and Clinical Centre of Pediatric Psychoneurology Moscow, Russi, Research and Clinical Centre of Pediatric Psychoneurology Moscow, Russia
| | - M E Guseva
- Pirogov Russian National Research University, Moscow, Russia
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73
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Money KM, Mahatoo A, Samaan S, Anand P, Baber U, Bailey M, Bakshi R, Bouley A, Bower A, Cahill J, Houtchens M, Katz J, Lathi E, Levit E, Longbrake EE, McAdams M, Napoli S, Raibagkar P, Wade P, Sloane JA. A New England COVID-19 Registry of Patients With CNS Demyelinating Disease: A Pilot Analysis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1046. [PMID: 34341094 PMCID: PMC8362350 DOI: 10.1212/nxi.0000000000001046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES We sought to define the risk of severe coronavirus disease 2019 (COVID-19) infection requiring hospitalization in patients with CNS demyelinating diseases such as MS and the factors that increase the risk for severe infection to guide decisions regarding patient care during the COVID-19 pandemic. METHODS A pilot cohort of 91 patients with confirmed or suspected COVID-19 infection from the Northeastern United States was analyzed to characterize patient risk factors and factors associated with an increased severity of COVID-19 infection. Univariate analysis of variance was performed using the Mann-Whitney U test or analysis of variance for continuous variables and the χ2 or Fisher exact test for nominal variables. Univariate and stepwise multivariate logistic regression identified clinical characteristics or symptoms associated with hospitalization. RESULTS Our cohort demonstrated a 27.5% hospitalization rate and a 4.4% case fatality rate. Performance on Timed 25-Foot Walk before COVID-19 infection, age, number of comorbidities, and presenting symptoms of nausea/vomiting and neurologic symptoms (e.g., paresthesia or weakness) were independent risk factors for hospitalization, whereas headache predicted a milder course without hospitalization. An absolute lymphocyte count was lower in hospitalized patients during COVID-19 infection. Use of disease-modifying therapy did not increase the risk of hospitalization but was associated with an increased need for respiratory support. DISCUSSION The case fatality and hospitalization rates in our cohort were similar to those found in MS and general population COVID-19 cohorts within the region. Hospitalization was associated with increased disability, age, and comorbidities but not disease-modifying therapy use.
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Affiliation(s)
- Kelli M Money
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Ashmanie Mahatoo
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Soleil Samaan
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Pria Anand
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Ursela Baber
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Mary Bailey
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Rohit Bakshi
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Andrew Bouley
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Aaron Bower
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Jonathan Cahill
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Maria Houtchens
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Joshua Katz
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Ellen Lathi
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Elle Levit
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Erin E Longbrake
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Matthew McAdams
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Salvatore Napoli
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Pooja Raibagkar
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Peter Wade
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH
| | - Jacob A Sloane
- From the Department of Neurology (K.M.M., A.M., S.S., U.B., J.A.S.), Beth Israel Deaconess Medical Center, Boston; Department of Neurology (P.A.), Boston University School of Medicine, MA; The Mandell Comprehensive MS Center (M.B., P.W.), Hartford, CT; Department of Neurology (R.B., M.H.), Brigham and Women's Hospital, Boston; The Elliot Lewis Center (A. Bouley, J.K., E. Lathi), Wellesley, MA; Department of Neurology (A. Bower, E. Levit, E.E.L.), Yale School of Medicine, New Haven, CT; Department of Neurology (J.C.), Alpert Medical School of Brown University, Providence, RI; Department of Neurology (M.M.), Lahey Hospital, Burlington; Neurology Center of New England (S.N.), Foxboro, MA; and Department of Neurology (P.R.), Concord Hospital, Concord, NH.
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Habek M. Chickenpox and asymptomatic COVID-19 after first cycle of alemtuzumab for multiple sclerosis. Neurol Sci 2021; 42:4003-4005. [PMID: 34331616 PMCID: PMC8325041 DOI: 10.1007/s10072-021-05495-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mario Habek
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
- School of Medicine, University of Zagreb, Zagreb, Croatia.
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Biolato M, Bianco A, Lucchini M, Gasbarrini A, Mirabella M, Grieco A. The Disease-Modifying Therapies of Relapsing-Remitting Multiple Sclerosis and Liver Injury: A Narrative Review. CNS Drugs 2021; 35:861-880. [PMID: 34319570 PMCID: PMC8354931 DOI: 10.1007/s40263-021-00842-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
In this narrative review, we analyze pre-registration and post-marketing data concerning hepatotoxicity of all disease-modifying therapies (DMTs) available for the treatment of relapsing-remitting multiple sclerosis, including beta interferon, glatiramer acetate, fingolimod, teriflunomide, dimethyl fumarate, cladribine, natalizumab, alemtuzumab, and ocrelizumab. We review the proposed causal mechanisms described in the literature and we also address issues like use of DMTs in patients with viral hepatitis or liver cirrhosis. Most data emerged in the post-marketing phase by reports to national pharmacovigilance agencies and published case reports or case series. Serious liver adverse events are rare, but exact incidence is largely unknown, as are predictive factors. Unfortunately, none of the DMTs currently available for the treatment of multiple sclerosis is free of potential hepatic toxic effects. Cases of acute liver failure have been reported for beta-interferon, fingolimod, natalizumab, alemtuzumab, and ocrelizumab by different mechanisms (idiosyncratic reaction, autoimmune hepatitis, or viral reactivation). Patients with multiple sclerosis should be informed about possible hepatic side effects of their treatment. Most cases of liver injury are idiosyncratic and unpredictable. The specific monitoring schedule for each DMT has been reviewed and the clinician should be ready to recognize clinical symptoms suggestive for liver injury. Not all DMTs are indicated in cirrhotic patients. For some DMTs, screening for hepatitis B virus and hepatitis C virus is required before starting treatment and a monitoring or antiviral prophylaxis schedule has been established. Beta interferon, glatiramer acetate, natalizumab, and alemtuzumab are relatively contraindicated in autoimmune hepatitis due to the risk of disease exacerbation.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
- Institute of Internal Medicine, Catholic University of Sacred Heart, 00168, Rome, Italy.
- Centro di ricerca per la Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Assunta Bianco
- Multiple Sclerosis Center, Department of Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Matteo Lucchini
- Multiple Sclerosis Center, Department of Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Centro di ricerca per la Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Institute of Internal Medicine, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Department of Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Centro di ricerca per la Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Antonio Grieco
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Institute of Internal Medicine, Catholic University of Sacred Heart, 00168, Rome, Italy
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Cajamarca-Baron J, Guavita-Navarro D, Buitrago-Bohorquez J, Gallego-Cardona L, Navas A, Cubides H, Arredondo AM, Escobar A, Rojas-Villarraga A. SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression. REUMATOLOGIA CLINICA 2021; 17:408-419. [PMID: 34301385 PMCID: PMC7566826 DOI: 10.1016/j.reumae.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is not clear whether patients with some degree of immunosuppression have worse outcomes in SARS-CoV-2 infection, compared to healthy people. OBJECTIVE To carry out a narrative review of the information available on infection by SARS-CoV-2 in immunosuppressed patients, especially patients with cancer, transplanted, neurological diseases, primary and secondary immunodeficiencies. RESULTS Patients with cancer and recent cancer treatment (chemotherapy or surgery) and SARS-CoV-2 infection have a higher risk of worse outcomes. In transplant patients (renal, cardiac and hepatic), with neurological pathologies (multiple sclerosis (MS), neuromyelitis optica (NMODS), myasthenia gravis (MG)), primary immunodeficiencies and infection with human immunodeficiency virus (HIV) in association with immunosuppressants, studies have shown no tendency for worse outcomes. CONCLUSION Given the little evidence we have so far, the behaviour of SARS-CoV-2 infection in immunosuppressed patients is unclear, but current studies have not shown worse outcomes, except for patients with cancer.
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Affiliation(s)
- Jairo Cajamarca-Baron
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia.
| | - Diana Guavita-Navarro
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | | | - Laura Gallego-Cardona
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | - Angela Navas
- Servicio de Neurología, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | - Hector Cubides
- Servicio de Reumatología, Hospital San José, Bogotá, Colombia
| | | | | | - Adriana Rojas-Villarraga
- Servicio de Reumatología, Instituto de Investigaciones, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
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Mancinelli CR, Rossi ND, Capra R. Ocrelizumab for the Treatment of Multiple Sclerosis: Safety, Efficacy, and Pharmacology. Ther Clin Risk Manag 2021; 17:765-776. [PMID: 34354358 PMCID: PMC8331077 DOI: 10.2147/tcrm.s282390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/18/2021] [Indexed: 11/23/2022] Open
Abstract
The success of selective B-cells depleting therapies, as the anti-CD20 antibodies, in patients with multiple sclerosis (MS) has confirmed that B-cells are critical in the immune pathogenesis of the disease. Ocrelizumab, a humanized monoclonal antibody that selectively targets CD20+ B-cells, profoundly suppresses acute inflammatory disease activity, representing a highly effective therapy for relapsing-remitting multiple sclerosis (RRMS). It is also the first proven therapy able to slow disability progression in primary progressive multiple sclerosis (PPMS), particularly in patients with signs of acute radiological activity before being enrolled. Effectiveness has widely been demonstrated in randomized clinical trials (RCTs), and recently confirmed in open-label extension trials. Here, we review the role of B-cells in MS, the mechanism of action of ocrelizumab, its pharmacokinetics and pharmacodynamics, and the clinical data supporting its use, as well as safety data. We focus on issues related to the maintenance of immunocompetence, essential to ensure an immune response to either a primary infection or a vaccination. Lastly, we discuss about the possible role of ocrelizumab as an exit strategy from natalizumab-treated patients at risk of developing multifocal progressive leukoencephalopathy. In view of using ocrelizumab chronically, collecting long-term safety data and finding strategies to minimize adverse events will be extremely relevant.
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Affiliation(s)
| | - Nicola De Rossi
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Brescia, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Brescia, Italy
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Monschein T, Zrzavy T, Löbermann M, Winkelmann A, Berger T, Rommer P, Hartung HP, Zettl UK. [The corona pandemic and multiple sclerosis: vaccinations and their implications for patients-Part 1: recommendations]. DER NERVENARZT 2021; 92:1276-1282. [PMID: 34232359 PMCID: PMC8261803 DOI: 10.1007/s00115-021-01155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 12/24/2022]
Abstract
The ongoing COVID-19 pandemic is a global health crisis. New challenges are constantly emerging especially for the healthcare system, not least with the emergence of various viral mutations. Given the variety of immunomodulatory and immunosuppressive therapies for multiple sclerosis (MS) and the immense developments in vaccine production, there is a high need of information for people with MS. The aim of this article is therefore to provide an overview of MS and COVID-19 as well as to clarify the implications for patients with MS, especially regarding vaccination and to formulate appropriate recommendations.
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Affiliation(s)
- Tobias Monschein
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich.
| | - Tobias Zrzavy
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich
| | - Micha Löbermann
- Abteilung für Tropenmedizin und Infektionskrankheiten, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Alexander Winkelmann
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Thomas Berger
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich
| | - Paulus Rommer
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich.,Klinik und Poliklinik für Neurologie, Neuroimmunologische Sektion, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Hans-Peter Hartung
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich. .,Klinik für Neurologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Uwe K Zettl
- Klinik und Poliklinik für Neurologie, Neuroimmunologische Sektion, Universitätsmedizin Rostock, Rostock, Deutschland
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79
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Manacorda T, Bandiera P, Terzuoli F, Ponzio M, Brichetto G, Zaratin P, Bezzini D, Battaglia MA. Impact of the COVID-19 pandemic on persons with multiple sclerosis: Early findings from a survey on disruptions in care and self-reported outcomes. J Health Serv Res Policy 2021; 26:189-197. [PMID: 33337256 PMCID: PMC8182334 DOI: 10.1177/1355819620975069] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the disruptions in care experienced by persons with Multiple Sclerosis in Italy due to the COVID-19 pandemic and the self-reported impact on their health and wellbeing. METHODS A cross-sectional online survey was completed by 2722 persons with Multiple Sclerosis, after Italy instituted a national lockdown in response to the pandemic. RESULTS Persons with Multiple Sclerosis reported that the pandemic caused broad disruptions to usual health and social care services, which impacted on their health and wellbeing. Disruptions in care were consistently associated with negative self-reported impacts on the expected progression of the disease, on out-of-pocket expenditure and on carer's stress. Psychological consequences were associated with interruption to usual psychological support, and concerns about the safety of care delivered in person. CONCLUSIONS The quality of life of persons with Multiple Sclerosis depends greatly on prompt access to a broad range of health and care services. Negative psychological impacts reported by persons with Multiple Sclerosis with less severe disabilities show that accessible integrated services are crucial for maintenance of their wellbeing. Most persons with Multiple Sclerosis with more severe disability experienced negative impacts on perceived health. Their carers compensating for lack of social input resulted in care overburden. As continuity of care is crucial for persons with Multiple Sclerosis, as well as for persons with chronic conditions in general, strategies must be in place to ensure it is included in future pandemic response plans.
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Affiliation(s)
- Tommaso Manacorda
- Research Fellow, Department of Health Services Research and
Policy, London School of Hygiene and Tropical Medicine, UK
- Expert Advisor, Italian Multiple Sclerosis Foundation,
Italy
| | - Paolo Bandiera
- Director, Advocacy and Legal Department, Italian Multiple
Sclerosis Society, Italy
| | - Federica Terzuoli
- Project Manager, Advocacy and Legal Department, Italian Multiple
Sclerosis Society, Italy
| | - Michela Ponzio
- Researcher, Scientific Research Area, Italian Multiple Sclerosis
Foundation, Italy
| | - Giampaolo Brichetto
- Researcher, Scientific Research Area, Italian Multiple Sclerosis
Foundation, Italy
- Clinical Director, AISM Rehabilitation Centre, Italian Multiple
Sclerosis Society, Italy
| | - Paola Zaratin
- Research Director, Scientific Research Area, Italian Multiple
Sclerosis Foundation, Italy
| | - Daiana Bezzini
- Researcher, Department of Life Sciences, University of Siena,
Italy
| | - Mario A Battaglia
- President, Italian Multiple Sclerosis Foundation and Professor,
Department of Life Sciences, University of Siena, Italy
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80
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Sen S, Karabudak R, Schiavetti I, Demir S, Ozakbas S, Tutuncu M, Petek Balci B, Turan OF, Uzunkopru C, Koseoglu M, Yetkin MF, Gunduz T, Gumus H, Kale Icen N, Carmisciano L, Terzi M, Acar P, Gungor Dogan I, Baba C, Tuncer A, Uygunoglu U, Sormani MP, Efendi H, Siva A. The outcome of a national MS-Covid-19 study: What the Turkish MS cohort reveals? Mult Scler Relat Disord 2021; 52:102968. [PMID: 33940495 PMCID: PMC8053402 DOI: 10.1016/j.msard.2021.102968] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The pandemic of the new type of corona virus infection 2019 [Covid-19] also affect people with Multiple Sclerosis (pwMS). Currently, the accumulating information on the effects of the infection regarding the demographic and clinical characteristics of the disease, as well as outcomes within different DMTs¸ enable us to have better practices on the management of the Covid-19 infection in pwMS. OBJECTIVE To investigate the incidence of coronavirus disease 2019 (Covid-19) and to reveal the relationship between the demographic-clinical and therapeutic features and the outcome of Covid-19 infection in a multi-center national cohort of pwMS. METHODS The Turkish Neurological Society-MS Study Group in association with the Italian MuSC-19 Study Group initiated this study. A web-based electronic Case Report Form (eCRF) of Study-MuSC-19 were used to collect the data. The demographic data and MS histories of the patients were obtained from the file tracking forms of the relevant clinics. RESULTS 309 MS patients with confirmed Covid-19 infection were included in this study. Two hundred nineteen (219) were females (70.9%). The mean age was 36.9, ranging from 18 to 66, 194 of them (62.8%) were under 40. The clinical phenotype was relapsing-remitting in 277 (89.6%) and progressive in 32 (10.4%). Disease duration ranged from 0.2 years to 31.4 years. The median EDSS was 1.5, ranging from 0 to 8.5. The EDSS score was<= 1 in 134 (43%) of the patients. 91.6% of the patients were on a DMT, Fingolimod was the most frequently used drug (22.0%), followed by Interferon (20.1%). The comorbidity rate is 11.7%. We were not able to detect any significant association of DMTs with Covid-19 severity. CONCLUSION The Turkish MS-Covid-19 cohort had confirmed that pwMS are not at risk of having a more severe COVID-19 outcome irrespective of the DMT that they are treated. In addition, due to being a younger population with less comorbidities most had a mild disease further highlight that the only associated risk factors for having a moderate to severe COVID-19 course are similar with the general population such as having comorbid conditions and being older.
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Affiliation(s)
- S Sen
- Ondokuz Mayis University School of Medicine Samsun, Turkey.
| | - R Karabudak
- Hacettepe University School of Medicine Ankara, Turkey
| | - I Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - S Demir
- Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Neurology Clinic, Istanbul, Turkey
| | - S Ozakbas
- Dokuz Eylül University School of Medicine Izmir, Turkey
| | - M Tutuncu
- Istanbul University Cerrahpasa School of Medicine Istanbul, Turkey
| | - B Petek Balci
- Haseki Research and Training Hospital, Neurology Clinic, Istanbul, Turkey
| | - O F Turan
- Uludag University School of Medicine Bursa, Turkey
| | - C Uzunkopru
- Katip Celebi University School of Medicine Izmir, Turkey
| | - M Koseoglu
- Bakırköy Prof. Dr. Mashar Osman Research and Training Hospital, Neurology Clinic, Istanbul, Turkey
| | - M F Yetkin
- Erciyes University School of Medicine Kayseri, Turkey
| | - T Gunduz
- Istanbul University Istanbul School of Medicine Istanbul, Turkey
| | - H Gumus
- Selcuk University School of Medicine Konya, Turkey
| | - N Kale Icen
- Bagcılar Research and Training Hospital, Neurology Clinic, Istanbul, Turkey
| | - L Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - M Terzi
- Ondokuz Mayis University School of Medicine Samsun, Turkey
| | - P Acar
- Hacettepe University School of Medicine Ankara, Turkey
| | - I Gungor Dogan
- Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Neurology Clinic, Istanbul, Turkey
| | - C Baba
- Dokuz Eylül University School of Medicine Izmir, Turkey
| | - A Tuncer
- Hacettepe University School of Medicine Ankara, Turkey
| | - U Uygunoglu
- Istanbul University Cerrahpasa School of Medicine Istanbul, Turkey
| | - M P Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - H Efendi
- Kocaeli University School of Medicine Kocaeli, Turkey
| | - A Siva
- Istanbul University Cerrahpasa School of Medicine Istanbul, Turkey
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81
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Schweitzer F, Laurent S, Fink GR, Barnett MH, Hartung HP, Warnke C. Effects of disease-modifying therapy on peripheral leukocytes in patients with multiple sclerosis. J Neurol 2021; 268:2379-2389. [PMID: 32036423 PMCID: PMC8217029 DOI: 10.1007/s00415-019-09690-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022]
Abstract
Modern disease-modifying therapies (DMTs) in multiple sclerosis (MS) have variable modes of action and selectively suppress or modulate the immune system. In this review, we summarize the predicted and intended as well as unwanted adverse effects on leukocytes in peripheral blood as a result of treatment with DMTs for MS. We link changes in laboratory tests to the possible therapeutic risks that include secondary autoimmunity, infections, and impaired response to vaccinations. Profound knowledge of the intended effects on leukocyte counts, in particular lymphocytes, explained by the mode of action, and adverse effects which may require additional laboratory and clinical vigilance or even drug discontinuation, is needed when prescribing DMTs to treat patients with MS.
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Affiliation(s)
- F Schweitzer
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - S Laurent
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - G R Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Michael H Barnett
- Department of Neurology, Royal Prince Alfred Hospital, and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - H P Hartung
- Department of Neurology, Medical Faculty, and Center for Neurology and Neuropsychiatry, LVR Klinikum, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - C Warnke
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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82
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't Hart BA, Luchicchi A, Schenk GJ, Stys PK, Geurts JJG. Mechanistic underpinning of an inside-out concept for autoimmunity in multiple sclerosis. Ann Clin Transl Neurol 2021; 8:1709-1719. [PMID: 34156169 PMCID: PMC8351380 DOI: 10.1002/acn3.51401] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/27/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
The neuroinflammatory disease multiple sclerosis is driven by autoimmune pathology in the central nervous system. However, the trigger of the autoimmune pathogenic process is unknown. MS models in immunologically naïve, specific‐pathogen‐free bred rodents support an exogenous trigger, such as an infection. The validity of this outside–in pathogenic concept for MS has been frequently challenged by the difficulty to translate pathogenic concepts developed in these models into effective therapies for the MS patient. Studies in well‐validated non‐human primate multiple sclerosis models where, just like in humans, the autoimmune pathogenic process develops from an experienced immune system trained by prior infections, rather support an endogenous trigger. Data reviewed here corroborate the validity of this inside–out pathogenic concept for multiple sclerosis. They also provide a plausible sequence of events reminiscent of Wilkin’s primary lesion theory: (i) that autoimmunity is a physiological response of the immune system against excess antigen turnover in diseased tissue (the primary lesion) and (ii) that individuals developing autoimmune disease are (genetically predisposed) high responders against critical antigens. Data obtained in multiple sclerosis brains reveal the presence in normally appearing white matter of myelinated axons where myelin sheaths have locally dissociated from their enwrapped axon (i.e., blistering). The ensuing disintegration of axon–myelin units potentially causes the excess systemic release of post‐translationally modified myelin. Data obtained in a unique primate multiple sclerosis model revealed a core pathogenic role of T cells present in the normal repertoire, which hyper‐react to post‐translationally modified (citrullinated) myelin–oligodendrocyte glycoprotein and evoke clinical and pathological aspects of multiple sclerosis.
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Affiliation(s)
- Bert A 't Hart
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands.,Department Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Antonio Luchicchi
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Geert J Schenk
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Peter K Stys
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Jeroen J G Geurts
- Department Anatomy and Neuroscience, University Medical Center Amsterdam, Amsterdam, The Netherlands
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83
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Bigaut K, Cohen M, Durand-Dubief F, Maillart E, Planque E, Zephir H, Lebrun-Frenay C, de Seze J. How to switch disease-modifying treatments in multiple sclerosis: Guidelines from the French Multiple Sclerosis Society (SFSEP). Mult Scler Relat Disord 2021; 53:103076. [PMID: 34161898 DOI: 10.1016/j.msard.2021.103076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Today, there are no recommendations on switching disease-modifying treatments (DMTs) in multiple sclerosis (MS). OBJECTIVES To establish guidelines on switching DMTs MS. METHODS A Steering Committee composed of seven MS experts from the French Group for Recommendations in Multiple Sclerosis (France4MS) defined 15 proposals. These proposals were then submitted to a Rating Group, composed of 48 French MS experts, for evaluation. The proposals were classified as 'appropriate', 'inappropriate' or 'uncertain'. RESULTS Switching from a first-line therapy to another first-line therapy or a second-line therapy could be done without a washout period. Switching from a second-line therapy to a first-line therapy could be done without a washout period with fingolimod or natalizumab, after 3 months with ocrelizumab or mitoxantrone, and, if disease activity occurs with alemtuzumab or cladribine. The switch from a second-line therapy to another second-line therapy could be done after a washout period of 1 month with fingolimod or natalizumab, after 3 months with ocrelizumab, after 6 months with mitoxantrone, and, if disease activity occurs, with alemtuzumab or cladribine. CONCLUSION This expert consensus approach provides physicians with some guidelines on optimizing the benefit/risk ratio when switching DMTs in patients with MS.
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Affiliation(s)
- Kévin Bigaut
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Mikaël Cohen
- Service de Neurologie, Centre Hospitalier Universitaire Pasteur 2, Nice, France
| | - Françoise Durand-Dubief
- Service de Neurologie, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France
| | - Elisabeth Maillart
- Service de Neurologie, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Evelyne Planque
- Service de Neurologie, Centre Hospitalier Emile Durkheim, Epinal, France
| | - Hélène Zephir
- Service de Neurologie, Centre Hospitalo-Universitaire de Lille, Lille, France
| | | | - Jérôme de Seze
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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84
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Brisset JC, Vukusic S, Cotton F. Update on brain MRI for the diagnosis and follow-up of MS patients. Presse Med 2021; 50:104067. [PMID: 33989722 DOI: 10.1016/j.lpm.2021.104067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022] Open
Abstract
Over the past decades, MRI has become a major tool in the diagnosis and the follow-up of patients with multiple sclerosis (MS), especially for monitoring the effectiveness of therapy. The recent international recommendations issued for the standardization of neurological and radiological clinical practices converge on many points. In this setting, recommendations made by the "Observatoire français de la sclérose en plaques", the French MS registry, can be distinguished by its interdisciplinary complementarity, its longevity, its size, and its positions in direct connection with the clinic. Hence, after suspicions of gadolinium deposition in the brain, with multiple warning from the American and European health authorities, a national consultation took place and resulted in limitation to useful injections. The precautionary principle prevailing, the patient receives a limited quantity of contrast product even if no clinically harmful manifestation has been detected to date. The result of this round table bringing together neurologists and neuroradiologists from specialized centers was published in the form of a recommendation in early 2020. The interest of this project also lies in the constant improvement of the management of patients with MS and the possibility of developing advanced techniques to assist the clinician. The aim of this review is to explain to the neurologist, the interest of following this imaging protocol both in his/her clinical practice and in the possibilities that this opens up.
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Affiliation(s)
- Jean-Christophe Brisset
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, 69003 Lyon, France
| | - Sandra Vukusic
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, 69003 Lyon, France; Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, 69677 Bron, France; Université de Lyon, Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - Francois Cotton
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, 69003 Lyon, France; Eugène Devic EDMUS Foundation Against Multiple Sclerosis (a government approved foundation), 69677 Bron, France; Inserm, UJM-Saint-Étienne, CNRS, CREATIS UMR 5220, U1206, INSA-Lyon, University Lyon, Université Claude-Bernard Lyon 1, 69495 Pierre-Bénite, France.
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85
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Oksbjerg NR, Nielsen SD, Blinkenberg M, Magyari M, Sellebjerg F. Anti-CD20 antibody therapy and risk of infection in patients with demyelinating diseases. Mult Scler Relat Disord 2021; 52:102988. [PMID: 33979772 DOI: 10.1016/j.msard.2021.102988] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anti-CD20 antibody therapy may be associated with an increased risk of infections. We therefore investigated risk factors for infection in patients with demyelinating diseases treated with anti-CD20 antibody therapy. METHODS In this retrospective uncontrolled study, patients ever treated with anti-CD20 antibodies at an academic clinic were identified through the Danish Multiple Sclerosis Registry (DMSR). Data were collected from medical charts and the DMSR. We assessed occurrence of severe infections (requiring hospitalization), varicella zoster virus (VZV), major comorbidities and routine laboratory values for lymphocytes, IgG and IgM. RESULTS A total of 447 patients ever treated with anti-CD20 antibody therapy were identified; of these 416 with 649 patient years of follow-up were still under therapy. In this group, seven patients had VZV infections, and 16 patients had been hospitalized with infections during up to three years of follow-up on anti-CD20 therapy. Comorbidity was recorded in 80 patients. The risk of severe infection was associated with comorbidities, higher age, longer duration of treatment, and higher Expanded Disability Status Scale (EDSS) scores. In multivariable analyses treatment duration, EDSS scores and presence of comorbidity were independently associated with risk of severe infections. Serum concentrations of IgG and IgM decreased with increasing duration of therapy but were not associated with risk of severe infections. Patients with VZV infection had lower lymphocyte counts and lower serum concentrations of IgM. In multivariable analyses only lymphocyte counts were independently associated with risk of VZV infection. CONCLUSIONS In this retrospective study of patients treated with anti-CD20 antibodies, the risk of infections requiring hospitalization was independently associated with comorbidities, duration of treatment, and higher EDSS scores. Risk of VZV infection was independently associated with lymphopenia. Future studies investigating strategies for mitigating risk of infection in patients treated with anti-CD20 antibodies are warranted, especially for older patients, patients with higher levels of disability and for patients with a longer duration of treatment.
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Affiliation(s)
- N R Oksbjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - S D Nielsen
- Department of Infectious Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Blinkenberg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - M Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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86
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Grieb P, Świątkiewicz M, Kamińska A, Jünemann A, Rejdak R, Rejdak K. Citicoline: A Candidate for Adjunct Treatment of Multiple Sclerosis. Pharmaceuticals (Basel) 2021; 14:ph14040326. [PMID: 33918331 PMCID: PMC8066453 DOI: 10.3390/ph14040326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
In remitting–relapsing multiple sclerosis (RR-MS), relapses are driven by autoreactive immune cells that enter the brain and spinal cord and damage myelin sheaths of axons in white and grey matter, whereas during remissions myelin is repaired by activated oligodendroglial cells. Disease-modifying therapies (DMTs) may either retard/attenuate myelin damage or promote/enhance/speed up myelin repair. Almost all currently approved DMTs inhibit myelin damage and are considerably toxic. Enhancement of myelin repair is considered an unmet medical need of MS patients. Citicoline, known for many years as a nootropic and neuroprotective drug and recently pronounced food supplement, has been found to be significantly efficacious in two complementary rodent models of MS, experimental autoimmune encephalomyelitis (EAE) and cuprizone-induced myelin toxicity. Moreover, citicoline treatment improves visual evoked potentials (VEPs) in glaucoma patients, which is relevant because VEP monitoring is frequently used as an indicator of remyelination in MS. Although over-the-counter availability of citicoline may impede its formal translation to the clinic of MS, evaluation of its efficacy for supporting remyelination in this disease is strongly indicated.
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Affiliation(s)
- Paweł Grieb
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland;
| | - Maciej Świątkiewicz
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland;
- Correspondence:
| | - Agnieszka Kamińska
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszynski University, 01-938 Warsaw, Poland;
| | - Anselm Jünemann
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (A.J.); (R.R.)
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (A.J.); (R.R.)
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, 20-954 Lublin, Poland;
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87
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Oakes RS, Tostanoski LH, Kapnick SM, Froimchuk E, Black SK, Zeng X, Jewell CM. Exploiting Rational Assembly to Map Distinct Roles of Regulatory Cues during Autoimmune Therapy. ACS NANO 2021; 15:4305-4320. [PMID: 33645967 PMCID: PMC8116774 DOI: 10.1021/acsnano.0c07440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Autoimmune diseases like multiple sclerosis (MS), type 1 diabetes, and lupus occur when the immune system attacks host tissue. Immunotherapies that promote selective tolerance without suppressing normal immune function are of tremendous interest. Here, nanotechnology was used for rational assembly of peptides and modulatory immune cues into immune complexes. Complexes containing self-peptides and regulatory nucleic acids reverse established paralysis in a preclinical MS model. Importantly, mice responding to immunotherapy maintain healthy, antigen-specific B and T cell responses during a foreign antigen challenge. A therapeutic library isolating specific components reveals that regulatory nucleic acids suppress inflammatory genes in innate immune cells, while disease-matched peptide sequences control specificity of tolerance. Distinct gene expression profiles in cells and animals are associated with the immune signals administered in particulate and soluble forms, highlighting the impact of biophysical presentation of signals. This work provides insight into the rational manipulation of immune signaling to drive tolerance.
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Affiliation(s)
- Robert S. Oakes
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
- United States Department of Veterans Affairs, VA Maryland Health Care System, 10 N Greene St, Baltimore, MD, 21201, USA
| | - Lisa H. Tostanoski
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
| | - Senta M. Kapnick
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
| | - Eugene Froimchuk
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
| | - Sheneil K. Black
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
| | - Xiangbin Zeng
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
| | - Christopher M. Jewell
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
- United States Department of Veterans Affairs, VA Maryland Health Care System, 10 N Greene St, Baltimore, MD, 21201, USA
- Robert E. Fischell Institute for Biomedical Devices, 5102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
- Department of Microbiology and Immunology, University of Maryland Medical School, 685 West Baltimore Street, HSF-I Suite 380, Baltimore, MD, 21201, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, 22 S Greene St, Baltimore, MD, 21201, USA
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88
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Otero-Romero S, Sánchez-Montalvá A, Vidal-Jordana A. Assessing and mitigating risk of infection in patients with multiple sclerosis on disease modifying treatment. Expert Rev Clin Immunol 2021; 17:285-300. [PMID: 33543657 DOI: 10.1080/1744666x.2021.1886924] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: The important development that the multiple sclerosis (MS) treatment field has experienced in the last years comes along with the need of dealing with new adverse events such as the increase risk of infections. In the shared therapeutic decision-making process, the MS expert neurologist should also balance the risks of specific infections under each particular treatment and be familiar with new mitigation strategies.Areas covered: In this review, the authors provide an up-to-date review of the infection risk associated with MS treatments with a specific focus on risk mitigating strategies. The search was conducted using Pubmed® database (2000 - present) to identify publications that reported infection rates and infection complications for each treatment (interferon beta, glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod, cladribine, natalizumab, alemtuzumab, rituximab, and ocrelizumab).Expert opinion: Since the emergence of the first natalizumab-related PML case, the arrival of new MS therapies has come hand in hand with new infectious complications. MS-specialist neurologist has to face new challenges regarding the management of immunosuppression-related infectious complications. The implementation of patient-centered management focus on preventive and mitigating strategies with a multidisciplinary approach should be seen in the future as a marker of excellence of MS management.
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Affiliation(s)
- Susana Otero-Romero
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases. Hospital Universitari Vall d'Hebron, International Health Program Catalan Institute of Health (PROSICS), Universitat Autònoma De Barcelona, Barcelona, Spain.,Micobacteria Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases (SEIMC), Spain
| | - Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat). Hospital Universitari Vall d'Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain
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89
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Alonso R, Silva B, Garcea O, Diaz PEC, Dos Passos GR, Navarro DAR, Valle LAG, Salinas LCR, Negrotto L, Luetic G, Tkachuk VA, Míguez J, de Bedoya FHD, Goiry LG, Sánchez NER, Burgos M, Steinberg J, Balbuena ME, Alvarez PM, López PA, Ysrraelit MC, León RA, Cohen AB, Gracia F, Molina O, Casas M, Deri NH, Pappolla A, Patrucco L, Cristiano E, Tavolini D, Nadur D, Granda AMT, Weiser R, Cassará FP, Sinay V, Rodríguez CC, Lazaro LG, Menichini ML, Piedrabuena R, Escobar GO, Carrá A, Chertcoff A, Pujols BS, Vrech C, Tarulla A, Carvajal R, Mainella C, Becker J, Peeters LM, Walton C, Serena MA, Nuñez S, Rojas JI. COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America: COVID-19 in MS and NMOSD patients in LATAM. Mult Scler Relat Disord 2021; 51:102886. [PMID: 33744758 PMCID: PMC7937038 DOI: 10.1016/j.msard.2021.102886] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 12/27/2022]
Abstract
Background There is no data regarding COVID-19 in Multiple Sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients in Latin America. Objective The objective of this study was to describe the clinical characteristics and outcomes of patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with COVID-19. Methods RELACOEM is a longitudinal, strictly observational registry of MS and NMOSD patients who suffer COVID-19 and Dengue in LATAM. Inclusion criteria to the registry were either: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a COVID-19 polymerase chain reaction (PCR) test on a nasopharyngeal swab; or (2) COVID-19–typical symptoms (triad of cough, fever, and asthenia) in an epidemic zone of COVID-19. Descriptive statistics were performed on demographic and clinical variables. The cohort was later stratified for MS and NMOSD and univariate and multivariate logistic regression analysis was performed to identify variables associated with hospitalizations/intensive critical units (ICU) admission. Results 145 patients were included in the registry from 15 countries and 51 treating physicians. A total of 129 (89%) were MS patients and 16 (11%) NMOSD. 81.4% patients had confirmed COVID-19 and 18.6% were suspected cases. 23 (15.8%) patients were hospitalized, 9 (6.2%) required ICU and 5 (3.4 %) died due to COVID-19. In MS patients, greater age (OR 1.17, 95% CI 1.05 – 1.25) and disease duration (OR 1.39, 95%CI 1.14-1.69) were associated with hospitalization/ICU. In NMOSD patients, a greater age (54.3 vs. 36 years, p=<0.001), increased EDSS (5.5 vs 2.9, p=0.0012) and disease duration (18.5 vs. 10.3 years, p=0.001) were significantly associated with hospitalization/ICU. Conclusion we found that in MS patients, age and disease duration was associated with hospitalization and ICU admission requirement, while age, disease duration and EDSS was associated in NMOSD.
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Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Orlando Garcea
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | | | | | | | | | | | | | | | | | - Fernando Hamuy Diaz de Bedoya
- Departamento de Neurologia, Hospital IMT, Paraguay; Departamento de Neurologia de Diagnóstico Codas Thompson, Paraguay
| | | | | | | | | | - Maria E Balbuena
- Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Debora Nadur
- Hospital Naval - Hospital de Clínicas, Buenos Aires, Argentina
| | | | | | - Fátima Pagani Cassará
- Hospital Universitario Austral, Buenos Aires, Argentina; Fundación Favaloro, Buenos Aires, Argentina
| | | | | | - Luciana G Lazaro
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | - Raúl Piedrabuena
- Clinica Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | | | | | | | | | | | | | | | - Jefferson Becker
- Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Liesbet M Peeters
- University Multiple Sclerosis Center; Biomedical Research Institute & Data Science Institute, Hasselt University, Belgium
| | | | | | - Sebastián Nuñez
- Infectious Diseases Unit Sanatorio Güemes, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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90
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Reder AT, Centonze D, Naylor ML, Nagpal A, Rajbhandari R, Altincatal A, Kim M, Berdofe A, Radhakrishnan M, Jung E, Sandrock AW, Smirnakis K, Popescu C, de Moor C. COVID-19 in Patients with Multiple Sclerosis: Associations with Disease-Modifying Therapies. CNS Drugs 2021; 35:317-330. [PMID: 33743151 PMCID: PMC7980129 DOI: 10.1007/s40263-021-00804-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) for multiple sclerosis (MS) target immunity and have the potential to increase the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and alter its clinical course. We assessed these risks in patients with MS (PwMS). OBJECTIVE The objective of this study was to describe the overall risk of coronavirus disease 2019 (COVID-19) infection, severe disease course, and potential population-level predictors of COVID-19 infection in PwMS, and to provide a context using a cohort of patients with systemic lupus erythematosus (SLE). In addition, the association of different MS DMTs with the incidence and clinical course of COVID-19 was evaluated. Safety data from the Biogen Global Safety Database are also presented on reported cases of COVID-19 in patients treated with Biogen MS therapies. METHODS The IBM® Explorys electronic health record database of > 72,000,000 patients from US healthcare networks identified patients with MS or SLE, with and without polymerase chain reaction-confirmed COVID-19. COVID-19 cumulative incidence, hospitalization, and deaths among DMT classes were compared using logistic regression (adjusted for age, sex, body mass index, comorbidities, and race/ethnicity). As a secondary data source to assess safety data, COVID-19 reports for Biogen MS therapies were extracted and described from Biogen's Global Safety Database. RESULTS 30,478 PwMS with an open DMT prescription were identified within Explorys; 344 were COVID-19 positive. The most significant risk factors for acquiring COVID-19 were comorbidity score ≥ 1, body mass index ≥ 30, and Black/African ancestry. Similar risk factors were also identified for patients with SLE. Patients with MS were less likely to develop COVID-19 when treated with interferons (0.61%) and glatiramer acetate (0.51%), vs all other MS DMTs (both p < 0.001); anti-CD20 therapy was associated with the highest risk (3.45%; p < 0.0001). In the Biogen Global Safety Database, we identified 1217 patients who were COVID-19 positive treated with intramuscular interferon beta-1a, peginterferon beta-1a, natalizumab, dimethyl fumarate, diroximel fumarate, or fampridine. CONCLUSIONS Comorbidities, obesity, and Black/African ancestry, but not age, were associated with a higher risk of SARS-CoV-2 infection in PwMS. Interferons and glatiramer acetate were associated with a reduced COVID-19 risk, whereas anti-CD20 therapies were associated with an increased risk, within the treated MS cohort. COVID-19 safety reports for patients receiving Biogen MS therapies were consistent with the Explorys database and MS literature, illustrating the replicability and power of this approach.
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Affiliation(s)
- Anthony T Reder
- Department of Neurology and Brain Research Institute, University of Chicago, Chicago, IL, USA.
| | - Diego Centonze
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy
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91
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Kappos L, Cohan S, Arnold DL, Robinson RR, Holman J, Fam S, Parks B, Xiao S, Castro-Borrero W. Safety and efficacy of daclizumab beta in patients with relapsing multiple sclerosis in a 5-year open-label study (EXTEND): final results following early termination. Ther Adv Neurol Disord 2021; 14:1756286420987941. [PMID: 33737954 PMCID: PMC7934044 DOI: 10.1177/1756286420987941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/23/2020] [Indexed: 01/21/2023] Open
Abstract
Background: EXTEND (NCT01797965), an open-label extension study, evaluated the safety and efficacy of daclizumab beta in participants with relapsing multiple sclerosis (MS) who had completed the randomized DECIDE study. Methods: Eligible participants who received either daclizumab beta or interferon beta-1a in DECIDE received daclizumab beta 150 mg subcutaneously every 4 weeks for up to 5 years in EXTEND, followed by 24 weeks of post-dosing follow-up. Safety and tolerability were evaluated, as were clinical efficacy and magnetic resonance imaging (MRI). EXTEND was terminated ahead of schedule by the sponsors. Results: The total safety population (N = 1203) received at least one dose of daclizumab beta in EXTEND. In the DECIDE and EXTEND combined periods, the median number of doses of daclizumab beta was 53; median time on treatment was 196 weeks. By 24 September 2018, the end of the study, 110/1203 (9%) participants had completed the protocol-specified treatment period and 1101/1203 (92%) had experienced an adverse event (AE). The most commonly reported AEs were MS relapse, nasopharyngitis, and upper respiratory tract infection. Hepatic events (18%), cutaneous events (45%), and infections (62%) were common treatment-related AEs. The incidence of serious AEs was 29%, most commonly MS relapse and infections. The incidence of immune-mediated disorders was 2%; three of seven were encephalitis. Two of six deaths were considered treatment related. In participants who received continuous daclizumab beta throughout DECIDE and EXTEND, the treatment effects on clinical and MRI outcomes were maintained for up to 6 years. Conclusion: Results from the combined DECIDE-EXTEND study elucidate outcomes of longer-term treatment with daclizumab beta in the clinical trial setting and underscore the importance of pharmacovigilance with immunomodulatory therapies in the real-world setting.
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Affiliation(s)
- Ludwig Kappos
- Research Center Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Medicine, Clinical Research, and Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Petersgaben 4, Basel, CH-4031, Switzerland
| | - Stanley Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence St. Joseph Health, Portland, OR, USA
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada NeuroRx Research, Montreal, QC, Canada
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92
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Sormani MP, De Rossi N, Schiavetti I, Carmisciano L, Cordioli C, Moiola L, Radaelli M, Immovilli P, Capobianco M, Trojano M, Zaratin P, Tedeschi G, Comi G, Battaglia MA, Patti F, Salvetti M. Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis. Ann Neurol 2021; 89:780-789. [PMID: 33480077 PMCID: PMC8013440 DOI: 10.1002/ana.26028] [Citation(s) in RCA: 332] [Impact Index Per Article: 110.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). METHODS We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. RESULTS Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. INTERPRETATION This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists. ANN NEUROL 2021;89:780-789.
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Affiliation(s)
- Maria P Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Lucia Moiola
- Department of Neurology, Multiple Sclerosis Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Marco Capobianco
- Department of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi, Orbassano, Torino, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - Paola Zaratin
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania, Naples, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario A Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy.,Department of Life Sciences, University of Siena, Siena, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy.,Centro Sclerosi Multipla, Policlinico Catania, University of Catania, Catania, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University of Rome, Rome, Italy.,Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy
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93
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Wijburg MT, Warnke C, McGuigan C, Koralnik IJ, Barkhof F, Killestein J, Wattjes MP. Pharmacovigilance during treatment of multiple sclerosis: early recognition of CNS complications. J Neurol Neurosurg Psychiatry 2021; 92:177-188. [PMID: 33229453 DOI: 10.1136/jnnp-2020-324534] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
An increasing number of highly effective disease-modifying therapies for people with multiple sclerosis (MS) have recently gained marketing approval. While the beneficial effects of these drugs in terms of clinical and imaging outcome measures is welcomed, these therapeutics are associated with substance-specific or group-specific adverse events that include severe and fatal complications. These adverse events comprise both infectious and non-infectious complications that can occur within, or outside of the central nervous system (CNS). Awareness and risk assessment strategies thus require interdisciplinary management, and robust clinical and paraclinical surveillance strategies. In this review, we discuss the current role of MRI in safety monitoring during pharmacovigilance of patients treated with (selective) immune suppressive therapies for MS. MRI, particularly brain MRI, has a pivotal role in the early diagnosis of CNS complications that potentially are severely debilitating and may even be lethal. Early recognition of such CNS complications may improve functional outcome and survival, and thus knowledge on MRI features of treatment-associated complications is of paramount importance to MS clinicians, but also of relevance to general neurologists and radiologists.
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Affiliation(s)
- Martijn T Wijburg
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands .,Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Clemens Warnke
- Department of Neurology, University Hospital Köln, University of Cologne, Köln, Germany.,Department of Neurology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Christopher McGuigan
- Department of Neurology, St Vincent's University Hospital & University College Dublin, Dublin, Ireland
| | - Igor J Koralnik
- Department of Neurological Sciences, Division of Neuroinfectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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94
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Evaluation of Urinary Tract Infection following Corticosteroid Therapy in Patients with Multiple Sclerosis Exacerbation. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2021; 2021:6616763. [PMID: 33603936 PMCID: PMC7870309 DOI: 10.1155/2021/6616763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
The first treatment for multiple sclerosis exacerbation is usually short-term intravenous methylprednisolone (IVMP), with or without a regimen of oral prednisone taper (OPT). This study aims to evaluate the effects of IVMP and OPT in comparison with IVMP alone in raising the risk of urinary tract infection (UTI) and posttreatment improvement of urinary tract symptoms in patients with relapsing-remitting multiple sclerosis. This double-blind randomized clinical trial was conducted on 56 people with multiple sclerosis relapse who had undergone methylprednisolone for 5 days. Patients were randomly split into two groups: oral prednisolone and placebo (tapering for 20 days). Demographic data, duration of multiple sclerosis, urinary tract symptoms, the Expanded Disability Status Scale (EDSS) score, and urine data were analyzed. The incidence of UTI in the intervention and control groups did not differ significantly (
). However, the improvement of urinary tract symptoms in the intervention group was significantly more favorable than in the control group (
). Furthermore, administering OPT after IVMP did not increase the risk of UTI occurrence in patients with multiple sclerosis exacerbation. The urine analysis results did not show any differences at baseline and after the corticosteroid tapering regimen. Due to the risk of infection by corticosteroids, it is no longer necessary to do further urinary screening in this group of patients.
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95
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Prevention and management of adverse effects of disease modifying treatments in multiple sclerosis. Curr Opin Neurol 2021; 33:286-294. [PMID: 32374570 DOI: 10.1097/wco.0000000000000824] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To summarize the currently known side effects of the approved therapies of multiple sclerosis and to suggest monitoring procedures. RECENT FINDINGS The progress in the treatment of multiple sclerosis with new very effective therapies is accompanied by a number of side effects. Some of these have already been described in the approval studies, but some only after approval in a real world situation. The reason for this is the short duration of the clinical studies, the very heterogeneous patient profile in the real world setting with a number of comorbidities, pretherapies, and wider age range. The side effects may occur during application of therapies or afterwards during the course of the treatment. The side effects may range from mild infections, mild laboratory abnormalities, secondary autoimmune diseases to life-threatening side effects such as progressive multifocal leukoencephalopathy. SUMMARY It has to be pointed out that these side effects are not to be considered as final and neurologists should be vigilant against new unknown side effects. The doctor should be aware of these undesirable effects, should weigh the benefits of the therapies against the risks, but at the same time she/he should keep in mind that multiple sclerosis can be a very disabling disease if not treated properly.
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96
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Chaudhry F, Jageka C, Levy PD, Cerghet M, Lisak RP. Review of the COVID-19 Risk in Multiple Sclerosis. JOURNAL OF CELLULAR IMMUNOLOGY 2021; 3:68-77. [PMID: 33959727 PMCID: PMC8098748 DOI: 10.33696/immunology.3.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The ongoing pandemic of the novel coronavirus of 2019 (COVID-19) has resulted in over 1 million deaths, primarily affecting older patients with chronic ailments. Multiple sclerosis (MS) patients have been deemed particularly vulnerable given their high rates of disability and increased susceptibility to infections. There have also been concerns regarding disease-modifying therapy (DMT) during the pandemic as many DMTs may increase the risk of infection due to some of their immunosuppressive properties. Furthermore, due to MS-related chronic inflammatory damage within the central nervous system, there have been concerns for worsening neurological injury by COVID-19. This has resulted in an alarmingly high level of anxiety and stress among the MS community leading to a lack of compliance with medications and routine check-ups, and even failure to obtain treatment for relapse. However, there is currently substantial evidence that MS and most DMT usage is not associated with increased COVID-19 severity. MS patients who suffer worse outcomes were more likely to be older and suffer from significant disabilities and comorbid conditions, which would also be expected from those in the general population. Likewise, there is little if any evidence demonstrating an increased susceptibility of MS patients to COVID-19-related neurological complications. Therefore, we aim to summarize the most recent findings related to COVID-19 and MS demonstrating that MS and most DMTs do not appear as risk factors for severe COVID-19.
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Affiliation(s)
- Farhan Chaudhry
- Department of Emergency Medicine and Integrative Biosciences, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
| | - Cristina Jageka
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
| | - Phillip D. Levy
- Department of Emergency Medicine and Integrative Biosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mirela Cerghet
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert P Lisak
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine and the Detroit Medical Center, Detroit, MI, USA
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97
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Santoro JD, Saucier LE, Tanna R, Wiegand SE, Pagarkar D, Tempchin AF, Khoshnood M, Ahsan N, Van Haren K. Inadequate Vaccine Responses in Children With Multiple Sclerosis. Front Pediatr 2021; 9:790159. [PMID: 34926358 PMCID: PMC8678906 DOI: 10.3389/fped.2021.790159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/10/2021] [Indexed: 01/05/2023] Open
Abstract
Objective: Immunizations against Hepatitis B virus (HBV) and Varicella Zoster virus (VZV), are recommended for patients with pediatric onset multiple sclerosis (POMS) and may be required prior to initiation of some disease modifying therapies. However, the efficacy of routine vaccine administration in POMS has never been studied. We sought to assess the humoral mediated vaccine response to HBV and VZV in children with POMS. Methods: A multi-center retrospective chart-based review of 62 patients with POMS was performed. Clinical data and antibody titers against HBV and VZV were collected prior to initiation of disease modifying therapy or steroids and compared to institutional control data, using t-test and chi squared analysis. Results: There were low rates of immunity against both HBV and VZV (33 and 25% respectively) among individuals with POMS. Fifteen individuals (24%) were non-immune to both. Compared to institutional control data, individuals with POMS were significantly less likely to be immune to and HBV (p = 0.003, 95% CI: 0.22-0.75) and VZV (p < 0.001, 95% CI: 0.09-0.39). Interpretation: Individuals with POMS have low rates of antibody-mediated immunity against HBV and VZV, despite receiving the appropriate vaccinations. This suggests an association between POMS and systemic immune dysregulation although further study is needed.
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Affiliation(s)
- Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Laura E Saucier
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Runi Tanna
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sarah E Wiegand
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Dania Pagarkar
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Adam F Tempchin
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mellad Khoshnood
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Nusrat Ahsan
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Keith Van Haren
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, United States
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98
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Graf J, Mares J, Barnett M, Aktas O, Albrecht P, Zamvil SS, Hartung HP. Targeting B cells to modify MS, NMOSD, and MOGAD: Part 2. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 8:8/1/e919. [PMID: 33411674 PMCID: PMC8063618 DOI: 10.1212/nxi.0000000000000919] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
Ocrelizumab, rituximab, ofatumumab, ublituximab, inebilizumab, and evobrutinib
are immunotherapies that target various B cell–related proteins. Most of
these treatments have proven efficacy in relapsing and progressive forms of MS
and neuromyelitis optica spectrum disease (NMOSD) or are in advanced stages of
clinical development. Currently, ocrelizumab and inebilizumab are licensed for
treatment of MS and NMOSD, respectively. This part of the review focuses on
monoclonal antibody B cell–depleting strategies in NMOSD and the emerging
related myelin oligodendrocyte glycoprotein (MOG) immunoglobulin
G–associated disease (MOGAD). Case series and phase 2/3 studies in these
inflammatory disorders are assessed. The safety profile of long-term B-cell
depletion in MS, NMOSD, and MOGAD will be highlighted. Finally implications of
the current coronavirus disease 2019 pandemic on the management of patients with
these disorders and the use of B cell–depleting agents will be
discussed.
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Affiliation(s)
- Jonas Graf
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Jan Mares
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Michael Barnett
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Orhan Aktas
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Philipp Albrecht
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Hans-Peter Hartung
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco.
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99
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COVID-19 in cladribine-treated relapsing-remitting multiple sclerosis patients: a monocentric experience. J Neurol 2020; 268:2697-2699. [PMID: 33216223 PMCID: PMC7677903 DOI: 10.1007/s00415-020-10309-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 01/11/2023]
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100
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Inhibition of Human Neutrophil Functions In Vitro by Multiple Sclerosis Disease-Modifying Therapies. J Clin Med 2020; 9:jcm9113542. [PMID: 33147889 PMCID: PMC7692529 DOI: 10.3390/jcm9113542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
There is a growing optimism about the potential of new disease-modifying therapies (DMTs) in the management of relapsing-remitting multiple sclerosis (RRMS) patients. However, this initial enthusiasm has been tempered by evidence indicating that multiple sclerosis (MS) patients undergoing DMT may be at higher risk of developing infections through incompletely understood mechanisms. As neutrophils provide the first line of defense against pathogens, here we have compared the effects of some of the commonly used MS DMTs (i.e., moderate-efficacy injective, first-line: interferonβ-1b (IFNβ-1b), glatiramer acetate (GA); and high-efficacy, second-line: fingolimod (FTY) and natalizumab (NAT)) on the in vitro viability and functions of neutrophils isolated from healthy subjects. All the DMTs tested impaired the ability of neutrophils to kill Klebsiella pneumoniae, whereas none of them affected the rate of neutrophil apoptosis or CD11b and CD62L cell surface expression. Intriguingly, only FTY exposure negatively affected K. pneumoniae-induced production of reactive oxygen species (ROS) in polymorphonuclear leukocytes (PMNs). Furthermore, neutrophils exposed to K. pneumoniae secreted enhanced amounts of CXCL8, IL-1β and TNF-α, which were differentially regulated following DMT pretreatment. Altogether, these findings suggest that DMTs may increase the susceptibility of MS patients to microbial infections, in part, through inhibition of neutrophil functions. In light of these data, we recommend that the design of personalized therapies for RRMS patients should take into account not just the mechanism of action of the chosen DMT but also the potential risk of infection associated with the administration of such therapeutic compounds to this highly vulnerable population.
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