1
|
Filipović SR, Özturk S, Bereczki D, Bodini B, Cavallieri F, Fanciulli A, Guekht A, Helbok R, Hochmeister S, Martinelli Boneschi F, Priori A, Rakusa M, Romoli M, Willekens B, Zedde M, Sellner J, Moro E. Management of patients with neurological diseases considering post-pandemic coronavirus disease 2019 (COVID-19) related risks and dangers - An updated European Academy of Neurology consensus statement. Eur J Neurol 2024:e16408. [PMID: 39088330 DOI: 10.1111/ene.16408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND AND PURPOSE In October 2020, the European Academy of Neurology (EAN) consensus statement for management of patients with neurological diseases during the coronavirus disease 2019 (COVID-19) pandemic was published. Due to important changes and developments that have happened since then, the need has arisen to critically reassess the original recommendations and address new challenges. METHODS In step 1, the original items were critically reviewed by the EAN COVID-19 Task Force. In addition, new recommendations were defined. In step 2, an online survey with the recommendations forged in step 1 was sent to the Managing Groups of all Scientific and Coordinating Panels of EAN. In step 3, the final set of recommendations was made. RESULTS In step 1, out of the original 36 recommendations, 18 were judged still relevant. They were edited to reflect the advances in knowledge and practice. In addition, 21 new recommendations were formulated to address the new knowledge and challenges. In step 2, out of the 39 recommendations sent for the survey, nine were approved as they were, whilst suggestions for improvement were given for the rest. In step 3, the recommendations were further edited, and some new items were formed to accommodate the participants' suggestions, resulting in a final set of 41 recommendations. CONCLUSION This revision of the 2020 EAN Statement provides updated comprehensive and structured guidance on good clinical practice in people with neurological disease faced with SARS-CoV-2 infection. It now covers the issues from the more recent domains of COVID-19-related care, vaccine complications and post-COVID-19 conditions.
Collapse
Affiliation(s)
- Saša R Filipović
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Serefnur Özturk
- Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Benedetta Bodini
- Neurology Department, St Antoine Hospital, APHP, Paris, France
- Paris Brain Institute, ICM, CNRS, INSERM, Sorbonne Université, Paris, France
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Alla Guekht
- Research and Clinical Centre for Neuropsychiatry, Moscow, Russian Federation
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Raimund Helbok
- Department of Neurology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | | | - Filippo Martinelli Boneschi
- Laboratory of Precision Medicine of Neurological Diseases, Department of Health Science, University of Milan, Milan, Italy
| | - Alberto Priori
- 'Aldo Ravelli' Centre for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
- Clinical Neurology Unit, 'Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo' and Department of Health Sciences, University of Milan, Milan, Italy
| | - Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, University of Antwerp, Wilrijk, Belgium
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, INSERM U1216, Grenoble Alpes University, Grenoble, France
| |
Collapse
|
2
|
Leston M, Ordóñez-Mena J, Joy M, de Lusignan S, Hobbs R, McInnes I, Lee L. Defining and Risk-Stratifying Immunosuppression (the DESTINIES Study): Protocol for an Electronic Delphi Study. JMIR Res Protoc 2024; 13:e56271. [PMID: 38842925 PMCID: PMC11190617 DOI: 10.2196/56271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Globally, there are marked inconsistencies in how immunosuppression is characterized and subdivided into clinical risk groups. This is detrimental to the precision and comparability of disease surveillance efforts-which has negative implications for the care of those who are immunosuppressed and their health outcomes. This was particularly apparent during the COVID-19 pandemic; despite collective motivation to protect these patients, conflicting clinical definitions created international rifts in how those who were immunosuppressed were monitored and managed during this period. We propose that international clinical consensus be built around the conditions that lead to immunosuppression and their gradations of severity concerning COVID-19. Such information can then be formalized into a digital phenotype to enhance disease surveillance and provide much-needed intelligence on risk-prioritizing these patients. OBJECTIVE We aim to demonstrate how electronic Delphi objectives, methodology, and statistical approaches will help address this lack of consensus internationally and deliver a COVID-19 risk-stratified phenotype for "adult immunosuppression." METHODS Leveraging existing evidence for heterogeneous COVID-19 outcomes in adults who are immunosuppressed, this work will recruit over 50 world-leading clinical, research, or policy experts in the area of immunology or clinical risk prioritization. After 2 rounds of clinical consensus building and 1 round of concluding debate, these panelists will confirm the medical conditions that should be classed as immunosuppressed and their differential vulnerability to COVID-19. Consensus statements on the time and dose dependencies of these risks will also be presented. This work will be conducted iteratively, with opportunities for panelists to ask clarifying questions between rounds and provide ongoing feedback to improve questionnaire items. Statistical analysis will focus on levels of agreement between responses. RESULTS This protocol outlines a robust method for improving consensus on the definition and meaningful subdivision of adult immunosuppression concerning COVID-19. Panelist recruitment took place between April and May of 2024; the target set for over 50 panelists was achieved. The study launched at the end of May and data collection is projected to end in July 2024. CONCLUSIONS This protocol, if fully implemented, will deliver a universally acceptable, clinically relevant, and electronic health record-compatible phenotype for adult immunosuppression. As well as having immediate value for COVID-19 resource prioritization, this exercise and its output hold prospective value for clinical decision-making across all diseases that disproportionately affect those who are immunosuppressed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/56271.
Collapse
Affiliation(s)
- Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - José Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Iain McInnes
- Wolfson Medical School Building, University of Glasgow, Glasgow, United Kingdom
| | - Lennard Lee
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
3
|
Moreno-Torres V, Martínez-Urbistondo M, Calderón-Parra J, de Mendoza C, Soriano V. COVID-19 mortality amongst the immunosuppresed. J Infect 2024; 88:106137. [PMID: 38479495 DOI: 10.1016/j.jinf.2024.106137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Víctor Moreno-Torres
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón, 28224 Madrid, Spain; Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain.
| | - María Martínez-Urbistondo
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain
| | - Jorge Calderón-Parra
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain
| | - Carmen de Mendoza
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain
| | - Vicente Soriano
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón, 28224 Madrid, Spain
| |
Collapse
|
4
|
Zhou J, Lan L, Ai S, Lin J, Liu N, Xie Y, Cui P, Liang H, Ye L, Huang J, Xie Z. People living with HIV who have poor immune status are a key population for SARS-CoV-2 prevention. J Infect 2024; 88:106122. [PMID: 38367706 DOI: 10.1016/j.jinf.2024.106122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Jie Zhou
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China; Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, Nanning 530021, Guangxi, China
| | - Liuyan Lan
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China; Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, Nanning 530021, Guangxi, China; The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Sufang Ai
- AIDS Clinical Treatment Center of Guangxi (Nanning) & The Fourth People's Hospital of Nanning, Nanning 530012, Guangxi, China
| | - Jianyan Lin
- AIDS Clinical Treatment Center of Guangxi (Nanning) & The Fourth People's Hospital of Nanning, Nanning 530012, Guangxi, China
| | - Ningmei Liu
- AIDS Clinical Treatment Center of Guangxi (Nanning) & The Fourth People's Hospital of Nanning, Nanning 530012, Guangxi, China
| | - Yulan Xie
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China; Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, Nanning 530021, Guangxi, China
| | - Ping Cui
- Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, Nanning 530021, Guangxi, China; Life Science Institute, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China; Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, Nanning 530021, Guangxi, China; Life Science Institute, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China; Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, Nanning 530021, Guangxi, China; Life Science Institute, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China; Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, Nanning 530021, Guangxi, China
| | - Zhiman Xie
- AIDS Clinical Treatment Center of Guangxi (Nanning) & The Fourth People's Hospital of Nanning, Nanning 530012, Guangxi, China.
| |
Collapse
|