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Hamzavi SS, Bahrololoom R, Saeb S, Marandi NH, Hosseini M, Hesam Abadi AK, Jamalidoust M. Humoral immune response and safety of Sars-Cov-2 vaccine in people with multiple sclerosis. BMC Immunol 2024; 25:35. [PMID: 38898409 PMCID: PMC11186195 DOI: 10.1186/s12865-024-00628-w] [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: 02/19/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND For the past three years, the pandemic has had a major effect on global public health, mainly on those with underlying medical conditions, such as people living with Multiple Sclerosis. Vaccination among this group is of great importance, and the long-term impacts of vaccination and its safety on the health of these patients will continue to be revealed. Therefore, risks related to vaccination and immune response need to be assessed. The objective here was to characterize the immune response, short-term safety, and the effects of multiple variables on these factors after COVID-19 vaccination (mainly Sinopharm) among people with Multiple Sclerosis. We assessed the short-term safety and humoral SARS-COV-2 anti-RBD IgG response using a data collection form and Immunoassay, respectively. RESULTS No severe adverse events or MS relapse was observed. Myalgia/body pain (26.7%), low-grade fever (22.2%), and mild headache (15.6%) were the most common adverse events. The use and type of vaccine influenced the frequency of side effects with a p-value < 0.0001. Regarding immune response, patients on rituximab and fingolimod had a lower antibody titer compared to other medications. With a significant difference, hybrid immunity (p-value: 0.047) and type of DMTs (p-value: 0.017) affected the humoral response. CONCLUSION There is a low incidence of serious adverse effects, MS worsening or relapse after COVID-19 vaccination, and mainly, side effects are similar to that of the general population. It appears that treatment with various disease-modifying therapies does not induce or worsen the post-vaccination side effects, although some, including Rituximab and fingolimod, may affect the immunity induced after vaccination.
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Affiliation(s)
- Seyedeh Sadigheh Hamzavi
- Department of Pediatrics, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, 71936-13311, Iran
| | - Rosemina Bahrololoom
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, 71936-13311, Iran.
| | - Sepideh Saeb
- Department of Virology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nahid Heydari Marandi
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, 71936-13311, Iran
| | - Marzieh Hosseini
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, 71936-13311, Iran
| | | | - Marzieh Jamalidoust
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, 71936-13311, Iran.
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Salvetti M, Wray S, Nelles G, Belviso N, Kumar A, Koster T, Castro-Borrero W, Vignos M. Safety and clinical effectiveness of peginterferon beta-1a for relapsing multiple sclerosis in a real-world setting: Final results from the Plegridy Observational Program. Mult Scler J Exp Transl Clin 2024; 10:20552173241238632. [PMID: 38784791 PMCID: PMC11113050 DOI: 10.1177/20552173241238632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/22/2024] [Indexed: 05/25/2024] Open
Abstract
Background Interferon beta-1a remains an important treatment option for multiple sclerosis, particularly when safety or tolerability concerns may outweigh the benefits of higher-efficacy disease-modifying therapies. The five-year phase 4 Plegridy Observational Program (POP) study (NCT02230969) collected data on real-world safety and effectiveness of Plegridy® (peginterferon beta-1a) treatment in patients with relapsing multiple sclerosis. Objective To explore the real-world safety and effectiveness of peginterferon beta-1a in patients with relapsing multiple sclerosis, including factors influencing treatment discontinuation. Methods Data were collected prospectively from patients ≥ 18 years old with relapsing multiple sclerosis for overall population analysis and for subpopulations including newly/previously diagnosed patients, age, and experience with peginterferon beta-1a. Outcome measures included annualized relapse rates, adverse events, and predictors of time to treatment discontinuation. Results Mean (SD) treatment duration in the overall population (N = 1172) was 896.0 (733.15) days. Incidence of adverse events was higher in new than experienced users (79.4% vs. 57.0%). New users were more likely than experienced users to discontinue (hazard ratio = 1.60; P < 0.0001). The adjusted annualized relapse rate was 0.09, and at the end of 5 years, 77.1% of patients were relapse-free. Conclusions Peginterferon beta-1a is an effective therapy for managing relapsing multiple sclerosis. The identification of predictors of discontinuation can help inform strategies to enhance treatment persistence.
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Affiliation(s)
- Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Molise, Italy
| | - Sibyl Wray
- Hope Neurology MS Center, Knoxville, TN, USA
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Todorović S, Vojinović S, Savić D, Aleksić D, Danilović M. Potential beneficial effect of IFN-β1a and ocrelizumab in people with MS during the COVID-19 pandemic. Acta Neurol Belg 2024; 124:447-455. [PMID: 37962785 DOI: 10.1007/s13760-023-02421-9] [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: 02/09/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND/AIM Disease-modifying therapy (DMT) has led to added challenges in the management of people with multiple sclerosis (pwMS) during the COVID-19 era. It can reduce relapse in MS or slow down disease progression, but some DMTs can increased risk of infection. The aim of study was to evaluate risk and severity of COVID-19 in pwMS. METHODS The examined group of pwMS were divided in group treated with IFN-β1a, group treated with ocrelizumab and untreated group. The examination included impact of age, gender, duration of MS, type of MS, vaccination status and Expanded Disability Status Scale (EDSS) on the risk and severity of COVID-19 infection. A diagnosis of COVID-19 in pwMS was confirmed by positive polymerase-chain-reaction (PCR) or antigen test. RESULTS Out of 207 pwMS, 82 patients were treated with ocrelizumab, 63 with IFN-β1a, while 62 patients were untreated pwMS. The average duration of the MS was longer in the group of patients treated with ocrelizumab than in the group treated with IFN-β1a (p < 0.05). EDSS was higher in the ocrelizumab group compared to the other two groups (p < 0.001). Untreated (more often unvaccinated) had the same COVID frequency as ocrelizumab-treated (more vaccinated, but higher EDSS). The multivariate logistic regression model indicated that administration of IFN-β1a reduces the risk of COVID-19 infection (p = 0.001, OR = 0.381, 95% CI 0.602-0.160). The use of both DMTs, driven mainly by the IFN-β1a effect, reduces the risk of moderate and severe COVID-19 (p < 0.05, OR = 0.105, 95% CI 0.011-0.968). CONCLUSION This study provides evidence that IFN-β1a can reduce the frequency of COVID-19 infection and that two DMTs, driven mainly by the IFN-β1a effect, do not increase the risk of moderate/severe COVID-19.
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Affiliation(s)
- Stefan Todorović
- Department of Neurology, University Clinical Center Niš, Blvd Dr Zoran Dindjic 48, 18000, Nis, Serbia.
| | - Slobodan Vojinović
- Department of Neurology, University Clinical Center Niš, Blvd Dr Zoran Dindjic 48, 18000, Nis, Serbia
- Faculty of Medicine, University of Niš, Nis, Serbia
| | - Dejan Savić
- Department of Neurology, University Clinical Center Niš, Blvd Dr Zoran Dindjic 48, 18000, Nis, Serbia
- Faculty of Medicine, University of Niš, Nis, Serbia
| | - Dejan Aleksić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Miloš Danilović
- Military Medical Academy, Clinic for Neurology, Belgrade, Serbia
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Freedman MS, Coyle PK, Hellwig K, Singer B, Wynn D, Weinstock-Guttman B, Markovic-Plese S, Galazka A, Dangond F, Korich J, Reder AT. Twenty Years of Subcutaneous Interferon-Beta-1a for Multiple Sclerosis: Contemporary Perspectives. Neurol Ther 2024; 13:283-322. [PMID: 38206453 PMCID: PMC10951191 DOI: 10.1007/s40120-023-00565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 01/12/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive, inflammatory disorder of the central nervous system. Relapsing-remitting MS (RRMS), the most common form of the disease, is characterized by transient neurological dysfunction with concurrent accumulation of disability. Over the past three decades, disease-modifying therapies (DMTs) capable of reducing the frequency of relapses and slowing disability worsening have been studied and approved for use in patients with RRMS. The first DMTs were interferon-betas (IFN-βs), which were approved in the 1990s. Among them was IFN-β-1a for subcutaneous (sc) injection (Rebif®), which was approved for the treatment of MS in Europe and Canada in 1998 and in the USA in 2002. Twenty years of clinical data and experience have supported the efficacy and safety of IFN-β-1a sc in the treatment of RRMS, including pivotal trials, real-world data, and extension studies lasting up to 15 years past initial treatment. Today, IFN-β-1a sc remains an important therapeutic option in clinical use, especially around pregnancy planning and lactation, and may also be considered for aging patients, in which MS activity declines and long-term immunosuppression associated with some alternative therapies is a concern. In addition, IFN-β-1a sc is used as a comparator in many clinical studies and provides a framework for research into the mechanisms by which MS begins and progresses.
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Affiliation(s)
- Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
- The Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada.
| | - Patricia K Coyle
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, New York, NY, 11794, USA
| | - Kerstin Hellwig
- Katholisches Klinikum Bochum, Ruhr University, 44787, Bochum, Germany
| | - Barry Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, 3009 N. Ballas Road, Suite 105B, St. Louis, MO, 63131, USA
| | - Daniel Wynn
- Neurology MS Center, Consultants in Neurology, Ltd, 1535 Lake Cook Road, Suite 601, Northbrook, IL, 60062, USA
| | - Bianca Weinstock-Guttman
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, 14215, USA
- Jacobs MS Center for Treatment and Research, Buffalo, NY, 14202, USA
- Pediatric MS Center, NY State MS Consortium, 1010 Main Street, Buffalo, NY, 14203, USA
| | - Silva Markovic-Plese
- Division of Neuroimmunology, Department of Neurology, Thomas Jefferson University, 900 Walnut St, Rm 305-B, Philadelphia, PA, 19107, USA
| | | | - Fernando Dangond
- EMD Serono Research & Development Institute Inc., an affiliate of Merck GKaA, Billerica, MA, 01821, USA
| | - Julie Korich
- EMD Serono Inc., an affiliate of Merck KGaA, Rockland, MA, 02370, USA
| | - Anthony T Reder
- Department of Neurology A-205, University of Chicago Medicine, MC-2030, 5841 S Maryland Ave, Chicago, IL, 60637, USA
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Komoni E, Jashari F, Boshnjaku D, Myftiu B, Pushka M, Blyta A, Nallbani-Komoni R. Risk Factors and Clinical Outcomes of COVID-19 Infection in Multiple Sclerosis Patients: A Retrospective Study from a Single Center in Kosovo. Med Sci Monit 2024; 30:e942992. [PMID: 38287659 PMCID: PMC10838007 DOI: 10.12659/msm.942992] [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: 10/26/2023] [Accepted: 11/21/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is treated with disease-modifying therapies (DMTs) that can increase susceptibility to viral infections. This retrospective study aimed to evaluate the presentation, management, and outcomes of patients with MS on DMTs admitted with symptoms of COVID-19 to a single center in Prishtina, Kosovo between March 2020 and April 2022. MATERIAL AND METHODS In this observational, single-center study, we included 282 patients with MS (mean age 37.8±11, 64.9% females), of whom 272 (96.4%) had confirmed COVID-19 infection, either through the presence of antibodies in the serum or a positive PCR test. RESULTS Most patients with COVID-19 infection were either asymptomatic or mildly symptomatic, while 11 patients were hospitalized due to moderate to severe symptoms. Among those with severe infection, 2 patients have died. Patients with moderate and severe COVID-19 had more advanced MS disease (P=0.001) and higher disability scales (P<0.001). In a logistic regression analysis, advanced MS remained significantly associated with worse symptoms, even after adjusting for other risk factors, with a relative risk (RR) of 2.8 (95% CI=1.1-6.6, P=0.018). MS patients on anti-CD20 DMTs more frequently experienced moderate and severe symptoms (RR=2.1, 95% CI=1.1-4.0, P=0.012). Anti-SARS-CoV-2 IgG was also lower in patients treated with anti-CD20. Notably, patients receiving vitamin D supplementation experienced a lower frequency of moderate to severe symptoms (P=0.007). CONCLUSIONS Patients with advanced MS exhibiting higher disability scales and those on anti-CD20 therapy faced an increased risk of experiencing more pronounced symptoms after COVID-19 infection. Patients on vitamin D supplementation had better clinical outcomes.
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Affiliation(s)
- Edmond Komoni
- Department of Neurology, Faculty of Medicine, University of Pristina “Hasan Prishtina”, Pristina, Kosovo
| | - Fisnik Jashari
- Department of Neurology, Faculty of Medicine, University of Pristina “Hasan Prishtina”, Pristina, Kosovo
| | - Dren Boshnjaku
- Department of Neurology, Faculty of Medicine, University of Pristina “Hasan Prishtina”, Pristina, Kosovo
| | - Blerim Myftiu
- Department of Neurology, University of Prishtina, Prishtina, Kosovo
| | - Melihate Pushka
- Department of Neurology, Faculty of Medicine, University of Pristina “Hasan Prishtina”, Pristina, Kosovo
| | - Afrim Blyta
- Department of Neurology, Faculty of Medicine, University of Pristina “Hasan Prishtina”, Pristina, Kosovo
| | - Rajmonda Nallbani-Komoni
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Prishtina, Prishtine, Kosovo
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Niu D, Wu Y, Lian J. Circular RNA vaccine in disease prevention and treatment. Signal Transduct Target Ther 2023; 8:341. [PMID: 37691066 PMCID: PMC10493228 DOI: 10.1038/s41392-023-01561-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/02/2023] [Accepted: 07/09/2023] [Indexed: 09/12/2023] Open
Abstract
CircRNAs are a class of single-stranded RNAs with covalently linked head-to-tail topology. In the decades since its initial discovery, their biogenesis, regulation, and function have rapidly disclosed, permitting a better understanding and adoption of them as new tools for medical applications. With the development of biotechnology and molecular medicine, artificial circRNAs have been engineered as a novel class of vaccines for disease treatment and prevention. Unlike the linear mRNA vaccine which applications were limited by its instability, inefficiency, and innate immunogenicity, circRNA vaccine which incorporate internal ribosome entry sites (IRESs) and open reading frame (ORF) provides an improved approach to RNA-based vaccination with safety, stability, simplicity of manufacture, and scalability. However, circRNA vaccines are at an early stage, and their optimization, delivery and applications require further development and evaluation. In this review, we comprehensively describe circRNA vaccine, including their history and superiority. We also summarize and discuss the current methodological research for circRNA vaccine preparation, including their design, synthesis, and purification. Finally, we highlight the delivery options of circRNA vaccine and its potential applications in diseases treatment and prevention. Considering their unique high stability, low immunogenicity, protein/peptide-coding capacity and special closed-loop construction, circRNA vaccine, and circRNA-based therapeutic platforms may have superior application prospects in a broad range of diseases.
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Affiliation(s)
- Dun Niu
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), 400038, Chongqing, China
- Department of Clinical Biochemistry, Army Medical University (Third Military Medical University), 400038, Chongqing, China
| | - Yaran Wu
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), 400038, Chongqing, China
- Department of Clinical Biochemistry, Army Medical University (Third Military Medical University), 400038, Chongqing, China
| | - Jiqin Lian
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), 400038, Chongqing, China.
- Department of Clinical Biochemistry, Army Medical University (Third Military Medical University), 400038, Chongqing, China.
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Zettl UK, Rommer PS, Aktas O, Wagner T, Richter J, Oschmann P, Cepek L, Elias-Hamp B, Gehring K, Chan A, Hecker M. Interferon beta-1a sc at 25 years: a mainstay in the treatment of multiple sclerosis over the period of one generation. Expert Rev Clin Immunol 2023; 19:1343-1359. [PMID: 37694381 DOI: 10.1080/1744666x.2023.2248391] [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: 06/07/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Interferon beta (IFN beta) preparations are an established group of drugs used for immunomodulation in patients with multiple sclerosis (MS). Subcutaneously (sc) applied interferon beta-1a (IFN beta-1a sc) has been in continuous clinical use for 25 years as a disease-modifying treatment. AREAS COVERED Based on data published since 2018, we discuss recent insights from analyses of the pivotal trial PRISMS and its long-term extension as well as from newer randomized studies with IFN beta-1a sc as the reference treatment, the use of IFN beta-1a sc across the patient life span and as a bridging therapy, recent data regarding the mechanisms of action, and potential benefits of IFN beta-1a sc regarding vaccine responses. EXPERT OPINION IFN beta-1a sc paved the way to effective immunomodulatory treatment of MS, enabled meaningful insights into the disease process, and remains a valid therapeutic option in selected vulnerable MS patient groups.
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Affiliation(s)
- Uwe Klaus Zettl
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Paulus Stefan Rommer
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | | - Andrew Chan
- Department of Neurology, Inselspital Bern, University Hospital Bern, Bern, Switzerland
| | - Michael Hecker
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
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Capone F, Rossi M, Cruciani A, Motolese F, Pilato F, Di Lazzaro V. Safety, immunogenicity, efficacy, and acceptability of COVID-19 vaccination in people with multiple sclerosis: a narrative review. Neural Regen Res 2023; 18:284-288. [PMID: 35900404 PMCID: PMC9396498 DOI: 10.4103/1673-5374.346539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the last two years, a new severe acute respiratory syndrome coronavirus (SARS-CoV) infection has spread worldwide leading to the death of millions. Vaccination represents the key factor in the global strategy against this pandemic, but it also poses several problems, especially for vulnerable people such as patients with multiple sclerosis. In this review, we have briefly summarized the main findings of the safety, efficacy, and acceptability of Coronavirus Disease 2019 (COVID-19) vaccination for multiple sclerosis patients. Although the acceptability of COVID-19 vaccines has progressively increased in the last year, a small but significant part of patients with multiple sclerosis still has relevant concerns about vaccination that make them hesitant about receiving the COVID-19 vaccine. Overall, available data suggest that the COVID-19 vaccination is safe and effective in multiple sclerosis patients, even though some pharmacological treatments such as anti-CD20 therapies or sphingosine l-phosphate receptor modulators can reduce the immune response to vaccination. Accordingly, COVID-19 vaccination should be strongly recommended for people with multiple sclerosis and, in patients treated with anti-CD20 therapies and sphingosine l-phosphate receptor modulators, and clinicians should evaluate the appropriate timing for vaccine administration. Further studies are necessary to understand the role of cellular immunity in COVID-19 vaccination and the possible usefulness of booster jabs. On the other hand, it is mandatory to learn more about the reasons why people refuse vaccination. This would help to design a more effective communication campaign aimed at increasing vaccination coverage among vulnerable people.
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Maniscalco GT, Liotti A, Ferrara AL, Prestipino E, Salvatore S, Di Battista ME, Moreggia O, Di Giulio Cesare D, Vastano R, Belardo M, Napolitano M, Ranieri A, Longo K, Andreone V, De Rosa V. Humoral efficacy of the third SARS-CoV-2 vaccine dose in Multiple Sclerosis subjects undergoing different disease-modifying therapies. Mult Scler Relat Disord 2022; 68:104371. [PMID: 36544318 PMCID: PMC9595409 DOI: 10.1016/j.msard.2022.104371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/03/2022] [Accepted: 10/21/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND It remains unclear how vaccine doses and combinations of vaccination and infection affect the magnitude and quality of immune responses, particularly against novel SARS-CoV-2 variants in subjects with immune-related disorders, such as people with multiple sclerosis (pwMS). Several studies have evaluated the duration of anti-SARS-CoV-2 immune protection in healthy individuals; however clinical data suggest an attenuated short-term humoral response to SARS-CoV-2 vaccines in pwMS receiving disease-modifying therapies (DMTs). METHODS In this prospective study, we evaluated the humoral response to the third (3rd) BNT162b2 vaccine (booster) dose in a monocentric cohort of pwMS undergoing eight different DMTs, all without previous SARS-CoV-2 infection. Quantitative determination of SARS-CoV-2 IgG Spike titre was carried out by anti-SARS-CoV-2 S assay in 65 pwMS and 9 healthy controls, all without previous SARS-CoV-2 infection. Moreover, these measurements were also compared to their relative levels at 21 days (T1) and ∼6 months (T2) after the second (2nd) vaccination. RESULTS We observed that the humoral response to the booster dose in Interferon β-1a-, Dimethyl fumarate- and Teriflunomide-treated pwMS is comparable to healthy controls, while increased in Cladribine-treated pwMS. Additionally, the 3rd dose elicits a seroconversion in the 100% of pwMS under Fingolimod and in the 65% of those under Ocrelizumab. Moreover, multivariate regression analysis showed that treatment with Interferon β-1a, Dimethyl fumarate and Cladribine positively associates with an increased humoral response. CONCLUSIONS Taken together this evidence strongly indicates the importance of the booster dose to enhance SARS-CoV-2-specific immunity especially in immunocompromised subjects, such as pwMS under DMTs.
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Affiliation(s)
- Giorgia Teresa Maniscalco
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy; Multiple Sclerosis Center, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Antonietta Liotti
- Institute of Experimental Endocrinology and Oncology (IEOS-CNR), Via S. Pansini 5, 80131, Naples 80131, Italy.
| | - Anne Lise Ferrara
- Institute of Experimental Endocrinology and Oncology (IEOS-CNR), Via S. Pansini 5, 80131, Naples 80131, Italy; Department of Translational Medical Science and Center for Basic and Clinical Immunology Research (CISI), University of Naples "Federico II", Via S. Pansini 5, Naples 80131, Italy.
| | - Elio Prestipino
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy; Multiple Sclerosis Center, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Simona Salvatore
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy; Multiple Sclerosis Center, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Maria Elena Di Battista
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy; Multiple Sclerosis Center, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Ornella Moreggia
- Multiple Sclerosis Center, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | | | - Roberta Vastano
- Department of Translational Medical Science and Center for Basic and Clinical Immunology Research (CISI), University of Naples "Federico II", Via S. Pansini 5, Naples 80131, Italy.
| | - Martina Belardo
- Department of Translational Medical Science and Center for Basic and Clinical Immunology Research (CISI), University of Naples "Federico II", Via S. Pansini 5, Naples 80131, Italy.
| | - Massimo Napolitano
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Angelo Ranieri
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Katia Longo
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Vincenzo Andreone
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Veronica De Rosa
- Institute of Experimental Endocrinology and Oncology (IEOS-CNR), Via S. Pansini 5, 80131, Naples 80131, Italy.
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The Safety Profile of COVID-19 Vaccines in Patients Diagnosed with Multiple Sclerosis: A Retrospective Observational Study. J Clin Med 2022; 11:jcm11226855. [PMID: 36431332 PMCID: PMC9692274 DOI: 10.3390/jcm11226855] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
In the current COVID-19 pandemic, patients diagnosed with multiple sclerosis (MS) are considered to be one of the highest priority categories, being recognized as extremely vulnerable people. For this reason, mRNA-based COVID-19 vaccines are strongly recommended for these patients. Despite encouraging results on the efficacy and safety profile of mRNA-based COVID-19 vaccines, to date, in frail populations, including patients diagnosed with MS, this information is rather limited. We carried out a retrospective observational study with the aim to evaluate the safety profile of mRNA-based COVID-19 vaccines by retrieving real-life data of MS patients who were treated and vaccinated at the Multiple Sclerosis Center of the Hospital A.O.R.N. A. Cardarelli. Three-hundred and ten medical records of MS patients who received the first dose of the mRNA-based COVID-19 vaccine were retrieved (63% female; mean age: 45.9 years). Of these patients, 288 also received the second dose. All patients received the Pfizer-BioNTech vaccine. Relapsing-Remitting Multiple Sclerosis (RRSM) was the most common form of MS. The Expanded Disability Status Scale (EDSS) values were <3.0 in 70% of patients. The majority of patients received a Disease Modifying Therapy (DMT) during the study period, mainly interferon beta 1-a, dimethyl fumarate, and natalizumab and fingolimod. Overall, 913 AEFIs were identified, of which 539 were after the first dose of the vaccine and 374 after the second dose. The majority of these AEFIs were classified as short-term since they occurred within the first 72 h. The most common identified adverse events were pain at injection site, flu-like symptoms, and headache. Fever was reported more frequently after the second dose than after the first dose. SARS-CoV-2 infection occurred in 3 patients after the first dose. Using historical data of previous years (2017−2020), the relapses’ rate during 2021 was found to be lower. Lastly, the results of the multivariable analysis that assessed factors associated with the occurrence of AEFIs revealed a statistical significance for age, sex, and therapy with ocrelizumab (p < 0.05). In conclusion, our results indicated that Pfizer-BioNTech vaccine was safe for MS patients, being associated with AEFIs already detected in the general population. Larger observational studies with longer follow-up and epidemiological studies are strongly needed.
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Etemadifar M, Nouri H, Pitzalis M, Idda ML, Salari M, Baratian M, Mahdavi S, Abhari AP, Sedaghat N. Multiple sclerosis disease-modifying therapies and COVID-19 vaccines: a practical review and meta-analysis. J Neurol Neurosurg Psychiatry 2022; 93:986-994. [PMID: 35688629 DOI: 10.1136/jnnp-2022-329123] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/10/2022] [Indexed: 12/19/2022]
Abstract
Studies among people with multiple sclerosis (pwMS) receiving disease-modifying therapies (DMTs) have provided adequate evidence for an appraisal of COVID-19 vaccination policies among them. To synthesise the available evidence addressing the effect of MS DMTs on COVID-19 vaccines' immunogenicity and effectiveness, following the Cochrane guidelines, we systematically reviewed all observational studies available in MEDLINE, Scopus, Web of Science, MedRxiv and Google Scholar from January 2021 to January 2022 and extracted their relevant data. Immunogenicity data were then synthesised in a quantitative, and other data in a qualitative manner. Evidence from 28 studies suggests extensively lower B-cell responses in sphingosine-1-phosphate receptor modulator (S1PRM) treated and anti-CD20 (aCD20) treated, and lower T-cell responses in interferon-treated, S1PRM-treated and cladribine-treated pwMS-although most T cell evidence currently comprises of low or very low certainty. With every 10-week increase in aCD20-to-vaccine period, a 1.94-fold (95% CI 1.57 to 2.41, p<0.00001) increase in the odds of seroconversion was observed. Furthermore, the evidence points out that B-cell-depleting therapies may accelerate postvaccination humoral waning, and boosters' immunogenicity is predictable with the same factors affecting the initial vaccination cycle. Four real-world studies further indicate that the comparative incidence/severity of breakthrough COVID-19 has been higher among the pwMS treated with S1PRM and aCD20-unlike the ones treated with other DMTs. S1PRM and aCD20 therapies were the only DMTs reducing the real-world effectiveness of COVID-19 vaccination among pwMS. Hence, it could be concluded that optimisation of humoral immunogenicity and ensuring its durability are the necessities of an effective COVID-19 vaccination policy among pwMS who receive DMTs.
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Affiliation(s)
- Masoud Etemadifar
- Neurosurgery Research Department, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hosein Nouri
- Neurosurgery Research Department, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - Maristella Pitzalis
- Institute of Genetic and Biomedical Research (IRGB) of the National Research Council (CNR), Cagliari, Italy
| | - Maria Laura Idda
- Institute of Genetic and Biomedical Research (IRGB) of the National Research Council (CNR), Cagliari, Italy
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Baratian
- Clinical Research Developement Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Sepide Mahdavi
- Clinical Research Developement Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Amir Parsa Abhari
- Neurosurgery Research Department, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - Nahad Sedaghat
- Neurosurgery Research Department, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran .,Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
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Gombolay GY, Dutt M, Tyor W. Immune responses to SARS-CoV-2 vaccination in multiple sclerosis: a systematic review/meta-analysis. Ann Clin Transl Neurol 2022; 9:1321-1331. [PMID: 35852423 PMCID: PMC9349877 DOI: 10.1002/acn3.51628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Responses to SARS-CoV-2 vaccination in patients with MS (pwMS) varies by disease-modifying therapies (DMTs). We perform a meta-analysis and systematic review of immune response to SARS-CoV-2 vaccines in pwMS. METHODS Two independent reviewers searched PubMed, Google Scholar, and Embase from January 1, 2019-December 31, 2021, excluding prior SARS-CoV-2 infections. The meta-analysis of observational studies in epidemiology (MOOSE) guidelines were applied. The data were pooled using a fixed-effects model. RESULTS Eight-hundred sixty-four healthy controls and 2203 pwMS from 31 studies were included. Antibodies were detected in 93% healthy controls (HCs), and 77% pwMS, with >93% responses in all DMTs (interferon-beta, glatiramer acetate, cladribine, natalizumab, dimethyl fumarate, alemtuzumab, and teriflunomide) except for 72% sphingosine-1-phosphate modulators (S1PM) and 44% anti-CD20 monoclonal antibodies (mAbs). T-cell responses were detected in most anti-CD20 and decreased in S1PM. Higher antibody response was observed in mRNA vaccines (99.7% HCs) versus non-mRNA vaccines (HCs: 72% inactivated virus; pwMS: 86% vector, 59% inactivated virus). A multivariate logistic regression model to predict vaccine response demonstrated that mRNA versus non-mRNA vaccines had a 3.4 odds ratio (OR) for developing immunity in anti-CD20 (p = 0.0052) and 7.9 OR in pwMS on S1PM or CD20 mAbs (p < 0.0001). Antibody testing timing did not affect antibody detection. CONCLUSION Antibody responses are decreased in S1PM and anti-CD20; however, cellular responses were positive in most anti-CD20 with decreased T cell responses in S1PM. mRNA vaccines had increased seroconversion rates compared to non-RNA vaccines. Further investigation in how DMTs affect vaccine immunity are needed.
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Affiliation(s)
- Grace Y. Gombolay
- Department of Pediatrics, Division of Pediatric NeurologyEmory University School of Medicine and Children's Healthcare of Atlanta1400 Tulle Road NE, 8 FloorAtlantaGeorgia30329USA
| | - Monideep Dutt
- Department of Pediatrics, Division of Pediatric NeurologyEmory University School of Medicine and Children's Healthcare of Atlanta1400 Tulle Road NE, 8 FloorAtlantaGeorgia30329USA
| | - William Tyor
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Atlanta VA Medical CenterDecaturGeorgiaUSA
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Brill L, Rechtman A, Shifrin A, Rozenberg A, Afanasiev S, Zveik O, Haham N, Levin N, Vaknin-Dembinsky A. Longitudinal humoral response in MS patients treated with cladribine tablets after receiving the second and third doses of SARS-CoV-2 mRNA vaccine. Mult Scler Relat Disord 2022; 63:103863. [PMID: 35667316 PMCID: PMC9088160 DOI: 10.1016/j.msard.2022.103863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) patients receive immunomodulatory treatments which can influence their ability to maintain vaccine specific serological response overtime. MS patients treated with cladribine tablets developed a positive serology response following two doses of mRNA COVID-19 vaccine. However, there is only limited data regarding the effect of cladribine tablets on long-term humoral response after the second and the third booster. METHODS Serology response to SARS-CoV-2 was tested in healthy controls (HCs) and MS patients treated with cladribine tablets 6 and 9-12 months after the second dose, and 1 and 3-6 months following the third booster-dose of the BTN162b2 mRNA vaccine. RESULTS Thirty-five out of 36 MS patients treated with cladribine tablets and 100% (46/46) of HCs had a positive serology response up to 10 months after the second vaccine dose. In addition, all cladribine tablets -treated MS patients (22/22) and HCs (24/24) had a positive robust serology response following the third vaccine with a positive humoral response sustain up to 6 months. One month after the third vaccine dose IgG levels were significantly lower in patients treated with cladribine tablets compared to HCs (15,598+11,313 vs 26,394+11,335, p<0.01). Six-month post second vaccine and 3-6 months post third vaccine there was no difference in IgG levels between the groups (1088.0 ± 1072.0 vs 1153.0 ± 997.1, p = 0.79; 5234+4097 vs 11,198+14,679, p = 0.4). CONCLUSION AND RELEVANCE MS patients treated with cladribine tablets have sustained positive vaccine specific serology response following the second and third SARS-CoV-2 vaccine dose.
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Affiliation(s)
- Livnat Brill
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center. Faculty of Medicine, Hebrew University of Jerusalem. Jerusalem, Israel
| | - Ariel Rechtman
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center. Faculty of Medicine, Hebrew University of Jerusalem. Jerusalem, Israel
| | - Alla Shifrin
- Department of Neurology, Rambam Health Care Campus and Technion Faculty of Medicine, Haifa, Israel
| | - Ayal Rozenberg
- Department of Neurology, Rambam Health Care Campus and Technion Faculty of Medicine, Haifa, Israel
| | - Svetlana Afanasiev
- Department of Neurology, Rambam Health Care Campus and Technion Faculty of Medicine, Haifa, Israel
| | - Omri Zveik
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center. Faculty of Medicine, Hebrew University of Jerusalem. Jerusalem, Israel
| | - Nitzan Haham
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center. Faculty of Medicine, Hebrew University of Jerusalem. Jerusalem, Israel
| | - Neta Levin
- Functional Imaging Unit, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center. Faculty of Medicine, Hebrew University of Jerusalem. Jerusalem, Israel
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Baron F, Canti L, Ariën KK, Kemlin D, Desombere I, Gerbaux M, Pannus P, Beguin Y, Marchant A, Humblet-Baron S. Insights From Early Clinical Trials Assessing Response to mRNA SARS-CoV-2 Vaccination in Immunocompromised Patients. Front Immunol 2022; 13:827242. [PMID: 35309332 PMCID: PMC8931657 DOI: 10.3389/fimmu.2022.827242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/04/2022] [Indexed: 12/25/2022] Open
Abstract
It is critical to protect immunocompromised patients against COVID-19 with effective SARS-CoV-2 vaccination as they have an increased risk of developing severe disease. This is challenging, however, since effective mRNA vaccination requires the successful cooperation of several components of the innate and adaptive immune systems, both of which can be severely affected/deficient in immunocompromised people. In this article, we first review current knowledge on the immunobiology of SARS-COV-2 mRNA vaccination in animal models and in healthy humans. Next, we summarize data from early trials of SARS-COV-2 mRNA vaccination in patients with secondary or primary immunodeficiency. These early clinical trials identified common predictors of lower response to the vaccine such as anti-CD19, anti-CD20 or anti-CD38 therapies, low (naive) CD4+ T-cell counts, genetic or therapeutic Bruton tyrosine kinase deficiency, treatment with antimetabolites, CTLA4 agonists or JAK inhibitors, and vaccination with BNT162b2 versus mRNA1273 vaccine. Finally, we review the first data on third dose mRNA vaccine administration in immunocompromised patients and discuss recent strategies of temporarily holding/pausing immunosuppressive medication during vaccination.
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Affiliation(s)
- Frédéric Baron
- Laboratory of Hematology, GIGA-I3, University of Liege and Centre Hospitalier Universitaire (CHU) of Liège, Liege, Belgium
- Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire (CHU) of Liège, Liège, Belgium
| | - Lorenzo Canti
- Laboratory of Hematology, GIGA-I3, University of Liege and Centre Hospitalier Universitaire (CHU) of Liège, Liege, Belgium
| | - Kevin K. Ariën
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Delphine Kemlin
- Department of Nephrology, Dialysis and Renal Transplantation, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Isabelle Desombere
- Scientific Directorate Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Margaux Gerbaux
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Université libre de Bruxelles (ULB), Gosselies, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
| | - Pieter Pannus
- Scientific Directorate Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Yves Beguin
- Laboratory of Hematology, GIGA-I3, University of Liege and Centre Hospitalier Universitaire (CHU) of Liège, Liege, Belgium
- Department of Medicine, Division of Hematology, Centre Hospitalier Universitaire (CHU) of Liège, Liège, Belgium
| | - Arnaud Marchant
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Université libre de Bruxelles (ULB), Gosselies, Belgium
| | - Stéphanie Humblet-Baron
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
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