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Lal AP, Foong YC, Sanfilippo PG, Spelman T, Rath L, Levitz D, Fabis-Pedrini M, Foschi M, Habek M, Kalincik T, Roos I, Lechner-Scott J, John N, Soysal A, D'Amico E, Gouider R, Mrabet S, Gross-Paju K, Cárdenas-Robledo S, Moghadasi AN, Sa MJ, Gray O, Oh J, Reddel S, Ramanathan S, Al-Harbi T, Altintas A, Hardy TA, Ozakbas S, Alroughani R, Kermode AG, Surcinelli A, Laureys G, Eichau S, Prat A, Girard M, Duquette P, Hodgkinson S, Ramo-Tello C, Maimone D, McCombe P, Spitaleri D, Sanchez-Menoyo JL, Yetkin MF, Baghbanian SM, Karabudak R, Al-Asmi A, Jakob GB, Khoury SJ, Etemadifar M, van Pesch V, Buzzard K, Taylor B, Butzkueven H, Van der Walt A. A multi-centre longitudinal study analysing multiple sclerosis disease-modifying therapy prescribing patterns during the COVID-19 pandemic. J Neurol 2024; 271:5813-5824. [PMID: 38935148 PMCID: PMC11377668 DOI: 10.1007/s00415-024-12518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (DMT), particularly anti-CD20 monoclonal antibodies (mAb) and fingolimod, could worsen COVID-19 in people with multiple sclerosis (pwMS). This study aimed to examine DMT prescribing trends pre- and post-pandemic onset. METHODS A multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018-March 10 2020) and post-pandemic onset (March 11 2020-11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use. RESULTS Post-pandemic onset, there was a significant increase in DMT initiation/switching to natalizumab and cladribine [(Natalizumab-initiation: OR 1.72, 95% CI 1.39-2.13; switching: OR 1.66, 95% CI 1.40-1.98), (Cladribine-initiation: OR 1.43, 95% CI 1.09-1.87; switching: OR 1.67, 95% CI 1.41-1.98)]. Anti-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (initiation: OR 1.26, 95% CI 1.06-1.49; Switching: OR 1.15, 95% CI 1.02-1.29. Initiation/switching of fingolimod, interferon-beta, and alemtuzumab significantly decreased [(Fingolimod-initiation: OR 0.55, 95% CI 0.41-0.73; switching: OR 0.49, 95% CI 0.41-0.58), (Interferon-gamma-initiation: OR 0.48, 95% CI 0.41-0.57; switching: OR 0.78, 95% CI 0.62-0.99), (Alemtuzumab-initiation: OR 0.27, 95% CI 0.15-0.48; switching: OR 0.27, 95% CI 0.17-0.44)]. CONCLUSIONS Post-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges.
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Affiliation(s)
- Anoushka P Lal
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
| | - Yi Chao Foong
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Paul G Sanfilippo
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - Tim Spelman
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - Louise Rath
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - David Levitz
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
| | - Marzena Fabis-Pedrini
- Perron Institute for Neurological and Translational Science, The University of Western Australia, Perth, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia
| | - Matteo Foschi
- Department of Neuroscience, MS Center, Neurology Unit, S. Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomas Kalincik
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Izanne Roos
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Nevin John
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- Department of Neurology, Monash Health, Clayton, Australia
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Emanuele D'Amico
- Medical and Surgical Sciences, Universita Di Foggia, Foggia, Italy
| | - Riadh Gouider
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Saloua Mrabet
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Katrin Gross-Paju
- Multiple Sclerosis Centre, West-Tallinn Central Hospital, Tallinn, Estonia
| | - Simón Cárdenas-Robledo
- Department of Neurology, Centro de Esclerosis Múltiple (CEMHUN), Hospital Universitario Nacional de Colombia Bogota, Bogota, Colombia
- Departamento de Medicina InternaFacultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
| | - Abdorreza Naser Moghadasi
- Multiple Research Centre, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Maria Jose Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - Orla Gray
- South Eastern HSC Trust, Belfast, UK
| | - Jiwon Oh
- St. Michael's Hospital, Toronto, Canada
| | - Stephen Reddel
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Concord Hospital, Sydney, Australia
| | - Talal Al-Harbi
- Neurology Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ayse Altintas
- Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey
| | - Todd A Hardy
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Serkan Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
- Multiple Sclerosis Research Association, Izmir, Turkey
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Allan G Kermode
- Perron Institute for Neurological and Translational Science, The University of Western Australia, Perth, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia
| | - Andrea Surcinelli
- Department of Neuroscience, MS Center, Neurology Unit, S. Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Guy Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Marc Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | | | - Suzanne Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
| | | | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Per L'Emergenza Cannizzaro, Catania, Italy
| | - Pamela McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Daniele Spitaleri
- Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Jose Luis Sanchez-Menoyo
- Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza-Basque Health Service, Galdakao, Spain
| | | | - Seyed Mohammad Baghbanian
- Neurology Department, Booalisina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rana Karabudak
- Department of Neurological Sciences, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
- Neuroimmunology Unit, Koşuyolu Hospitals, Istanbul, Turkey
| | - Abdullah Al-Asmi
- College of Medicine & Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman
| | - Gregor Brecl Jakob
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Masoud Etemadifar
- Neurology, Dr. Etemadifar MS Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
| | - Anneke Van der Walt
- Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia.
- Department of Neurology, The Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia.
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Abramoff BA, Hentschel C, Dillingham IA, Dillingham T, Baraniecki-Zwil G, Williams A, Pezzin LE. The association of multiple sclerosis, traumatic brain injury, and spinal cord injury to acute and long COVID-19 outcomes. PM R 2024; 16:553-562. [PMID: 38145343 PMCID: PMC11189756 DOI: 10.1002/pmrj.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/06/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Although persons with disabilities are a high-risk group, little is known about the association between specific disabling conditions and acute or long COVID outcomes. OBJECTIVE To examine the severity of acute SARS-CoV-2 infection and post-COVID outcomes among people with a preexisting diagnosis of multiple sclerosis (MS), spinal cord injury (SCI), or traumatic brain injury (TBI). METHODS This was a retrospective cohort study using the TrinetX Research Database, a large representative database of medical records. COVID-19-positive persons with MS, SCI, or TBI (cases) were matched 1:1 on age, gender, race, ethnicity, and comorbidities to COVID-19-positive persons without these diagnoses (controls). The main outcomes assessed were hospitalization for acute COVID-19, length of stay (LOS), the total number of hospitalizations, mortality, and incidence of six prevalent post-COVID sequelae within 6 months following a COVID-19 diagnosis. RESULTS There were 388,297 laboratory-confirmed COVID-19 cases identified. Of these cases, 2204 individuals had one of the following preexisting diagnoses: 51.3% TBI, 31.4% MS, and 17.3% SCI. People with TBI, MS, and SCI were significantly more likely to be hospitalized for COVID-19 (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.03-1.46) than matched controls. There was no difference in LOS, total hospitalizations, or mortality during the 6 months following the initial COVID diagnosis. Multivariable analyses reveal that persons with TBI, MS, and SCI were more likely to experience new weakness (OR = 1.54, 95% CI = 1.19-2.00), mobility difficulties (OR = 1.66, 95% CI = 1.17-2.35), and cognitive dysfunction (OR = 1.79, 95% CI = 1.38-2.33) than controls, even after controlling for the presence of these symptoms prior to their COVID infection and other risk factors. There were no differences in fatigue, pain, or dyspnea. CONCLUSIONS Having a history of MS, SCI or TBI was not associated with higher mortality risk from COVID-19. However, associations between these diagnoses and postacute COVID-19 symptoms raise concern about widening health outcome disparities for individuals with such potentially disabling conditions following COVID-19 infection.
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Affiliation(s)
- Benjamin A. Abramoff
- Department of Physical Medicine and Rehabilitation, The University of Pennsylvania- Perelman School of Medicine 1800 Lombard Street, Philadelphia, PA 19146
| | - Claudia Hentschel
- Department of Physical Medicine and Rehabilitation, Harvard University School of Medicine, 25 Shattuck Street Boston, MA 02115
| | | | - Timothy Dillingham
- Department of Physical Medicine and Rehabilitation, The University of Pennsylvania- Perelman School of Medicine 1800 Lombard Street, Philadelphia, PA 19146
| | - Gwen Baraniecki-Zwil
- Department of Physical Medicine and Rehabilitation, The University of Pennsylvania- Perelman School of Medicine 1800 Lombard Street, Philadelphia, PA 19146
| | - Asha Williams
- Lincoln University, 1570 Baltimore Pike, Lincoln University, PA, 19352
| | - Liliana E. Pezzin
- Institute of Health and Equity, Collaborative for Healthcare and Delivery Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226
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Murley C, Pettersson E, Hillert J, Machado A, Friberg E. Coronavirus disease 2019 infection among working-aged people with multiple sclerosis and the impact of disease-modifying therapies. Mult Scler J Exp Transl Clin 2024; 10:20552173241248293. [PMID: 38680165 PMCID: PMC11055478 DOI: 10.1177/20552173241248293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
Background The risk of coronavirus disease 2019 among people with multiple sclerosis with different disease-modifying therapies is not well established. Objective To investigate the occurrence of coronavirus disease 2019 and the remaining symptoms among people with multiple sclerosis and the associations with different disease-modifying therapies. Methods Individuals aged 20-50 listed in the Swedish Multiple Sclerosis Registry were invited to participate in a survey in 2021. Information on reported coronavirus disease 2019 infection and remaining symptoms were linked to individual-level register data. The risks by disease-modifying therapy of having coronavirus disease 2019 or having remaining symptoms were estimated with logistic regression. Results Of the 4393 participants, 1030 (23.4%) self-reported coronavirus disease 2019 (749 confirmed and 281 suspected). The observed odds for coronavirus disease 2019 did not differ by disease-modifying therapy (p-values <0.05). The majority reporting coronavirus disease 2019 had fully recovered (68.5%), 4.2% were currently/recently sick, and 27.0% had symptoms remaining after 2 months. The most frequently reported remaining symptoms involved one's sense of smell or taste (37.0%), fatigue (20.0%), and breathing (12.0%). No statistically significant associations were observed between having remaining symptoms and the disease-modifying therapy. Conclusion Despite the initial concerns of differing infection risks by MS treatments, we observed no differences in coronavirus disease 2019 occurrence or remaining symptoms among those who had coronavirus disease 2019. Nonetheless, exercising caution in interpreting our findings, it remains implicit that people with multiple sclerosis are particularly susceptible to infection and that lingering symptoms may persist beyond the initial infection.
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Affiliation(s)
- Chantelle Murley
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emma Pettersson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alejandra Machado
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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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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Yepanchintseva O, Babenko V, Yarosh V, Golubovska O. The course of COVID-19 in a multiple sclerosis: a case report. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:166-170. [PMID: 38431822 DOI: 10.36740/wlek202401121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
The authors present the case of a prolonged course of COVID 19 disease in a 37-year-old patient with multiple sclerosis on anti-CD20 monoclonal antibodies immunotherapy. This publication presents a clinical case of the course of COVID-19 disease in a multiple sclerosis patient receiving ublituximab therapy. The use of disease-modifying anti-CD20 monoclonal antibody therapy was associated with a protracted wave-like course of COVID-19 with the addition of a bacterial infection. This publication illustrates the key mechanisms and approaches to the treatment of such a cohort of patients. The use of highly effective multiple sclerosis treatment methods may be associated with an increase in the incidence of COVID-19 and worsening of its course. Multiple sclerosis patients receiving anti-CD20 therapy are at particular risk of a wave-like course of COVID-19, caused by immunosuppression, creates a basis for bacterial and fungal coinfection.
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Affiliation(s)
- Olga Yepanchintseva
- HEART INSTITUTE OF THE MINISTRY OF HEALTH OF UKRAINE, KYIV, UKRAINE; SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | - Vasyl Babenko
- HEART INSTITUTE OF THE MINISTRY OF HEALTH OF UKRAINE, KYIV, UKRAINE
| | - Vitalina Yarosh
- HEART INSTITUTE OF THE MINISTRY OF HEALTH OF UKRAINE, KYIV, UKRAINE
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Bakirtzis C, Konstantinidou N, Stavropoulou De Lorenzo S, Moysiadis T, Boziki MK, Grigoriadou E, Kesidou E, Theotokis P, Thireos E, Mitrou P, Grigoriadis N. COVID-19 Vaccination and Disease Course in People with Multiple Sclerosis in Greece. J Clin Med 2023; 12:5460. [PMID: 37685528 PMCID: PMC10488265 DOI: 10.3390/jcm12175460] [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: 06/19/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Over the past three years, humanity faced the abrupt spread of COVID-19, responsible for a worldwide health crisis. Initially, it was believed that individuals with chronic disorders, including multiple sclerosis, were more likely to be infected and suffer a worse degree of COVID-19 disease. Therefore, data with regard to COVID-19 disease outcomes in these populations may provide additional insight with regard to the management of chronic diseases during viral pandemics. The objective of this study is to evaluate COVID-19 disease course in people with multiple sclerosis (PwMS) during the COVID-19 pandemic in Greece and explore the impact of vaccination in the outcome of SARS-CoV-2 infection in this population. Anonymized data, extracted from nationwide administrative records between February 2020 and December 2021, were retrospectively analyzed in order to identify PwMS with SARS-CoV-2 infection. Demographic data, as well as data regarding COVID-19 infection and vaccination, were additionally collected. The study sample included 2351 PwMS (65.1% females, 51.2% unvaccinated at the time of infection). A total of 260 PwMS were hospitalized, while 25 PwMS died from COVID-19 disease and its complications. Older age, male sex and the presence of comorbidities were independently associated with a higher probability of hospitalization. The risk of hospitalization was decreased in PwMS receiving some disease-modifying treatments. Anti-CD20s demonstrated high odds ratios without reaching statistical significance. Regarding fatal outcome, only age reached statistical significance. Vaccination provided a significant protective effect against hospitalization but did not exhibit a statistically significant effect on mortality.
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Affiliation(s)
- Christos Bakirtzis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Natalia Konstantinidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Sotiria Stavropoulou De Lorenzo
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417 Nicosia, Cyprus;
| | - Marina-Kleopatra Boziki
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Eleni Grigoriadou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Evangelia Kesidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Paschalis Theotokis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Eleftherios Thireos
- Primary Health Center of Vari, National Health System of Greece, 16672 Athens, Greece;
| | - Panagiota Mitrou
- Independent Department of Therapeutic Protocols and Patient Registers, Hellenic Ministry of Health, 10433 Athens, Greece;
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
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Sadeghi P, Pezeshki PS, Rezaei N. Coronavirus disease 2019 (COVID-19) in pediatric patients with autoimmune disorders. Eur J Pediatr 2023:10.1007/s00431-023-04958-6. [PMID: 37074460 PMCID: PMC10113973 DOI: 10.1007/s00431-023-04958-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
Coronavirus disease 2019 (COVID-19) infection in pediatric patients with autoimmune disorders is an area of particular concern since autoimmune diseases can increase the risk of complications from the virus. However, as the infection rates were significantly higher in adults compared to children, this at-risk group of children was relatively underrepresented in COVID-19 research. The underlying inflammatory basis of autoimmune diseases and medications that affect the immune system, such as corticosteroids, could increase the risk of severe infection in this group of patients. COVID-19 could reportedly lead to a variety of alterations in the immune system. These alterations are plausibly dependent on the underlying immune-mediated diseases or prior use of immunomodulatory drugs. Patients administrating immunomodulatory agents, especially those with severe immune system dysregulation, can experience severe symptoms of COVID-19. Nonetheless, receiving immunosuppressive medications can benefit patients by preventing cytokine storm syndromes and lung tissue damage, threatening outcomes of COVID-19. CONCLUSION In this review, we sought to evaluate the currently available literature on the impact of autoimmune disease and its related therapeutic approaches on the COVID-19 infection course of disease in children and reflect on the gaps in the evidence and the need for further research in this field. WHAT IS KNOWN • The majority of children infected with COVID-19 demonstrate mild to moderate clinical manifestations compared to adults, whereas those children with pre-existing autoimmune conditions are at a greater risk for severe symptoms. •There is currently limited understanding of the pathophysiology and clinical outcomes of COVID-19 in pediatric patients with autoimmune disorders due to scattered reports and inadequate evidence. WHAT IS NEW • Generally, children with autoimmune disorders have more unfavorable outcomes than healthy children; yet, the severity is not extreme, and is highly dependent on their autoimmune disease type and severity, as well as the medication they are taking.
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Affiliation(s)
- Parniyan Sadeghi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Parmida Sadat Pezeshki
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Research Center for Immunodeficiencies, Children's Medical Center Hospital, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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8
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Liu N, Yu W, Sun M, Zhang W, Zhou D, Sun J, Wang M. Outcome of COVID-19 Infection in Patients With Multiple Sclerosis Who Received Disease-Modifying Therapies: A Systematic Review and Meta-Analysis. J Clin Neurol 2023:19.e26. [PMID: 36929061 DOI: 10.3988/jcn.2022.0348] [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: 09/14/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND AND PURPOSE A systematic review and meta-analysis was performed of the outcome of Coronavirus disease 2019 (COVID-19) infection in patients with multiple sclerosis (MS) who received disease-modifying therapies (DMTs). METHODS Relevant studies published before November 2022 in the PubMed, Cochrane Library, Chinese National Knowledge Infrastructure, and Web of Science databases were retrieved using the following search expression: ("multiple sclerosis" OR "MS") AND ("DMT" OR "disease modifying therapies") AND ("COVID-19"). Two authors independently screened the articles and extracted the data. Qualitative analyses and a meta-analysis constituted 22 of the 794 retrieved articles. Differences in the hospitalization and mortality rates were used as the main measures of efficacy, and the meta-analysis was performed using RevMan software. RESULTS 22 clinical trials were selected. The hospitalization rate was lower in the 3,216 patients who received DMTs than in the 774 patients who did not receive any treatment, with a moderate effect size of 0.43 (p<0.00001). The mortality rate was also lower among patients with MS treated using DMTs than in controls (odds ratio [OR]=0.19, 95% confidence interval [CI]=0.13-0.27, p<0.00001). The hospitalization rates for COVID-19 infection in patients with MS treated with anti-CD20 therapy also increased markedly (OR=3.32, 95% CI=2.63-4.20, p<0.00001). However, there was no significant difference between patients with MS who did and did not receive DMTs. CONCLUSIONS In summary, the application of DMTs was found to be valuable for patients with MS infected with COVID-19. However, more clinical studies are needed to determine the use of anti-CD20 drugs in patients with MS during the COVID-19 pandemic.
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Affiliation(s)
- Ning Liu
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - WuHan Yu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Mengjiao Sun
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Wenjing Zhang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Dan Zhou
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Sun
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - ManXia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China.
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9
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Di Stadio A, Bernitsas E, La Mantia I, Brenner MJ, Ralli M, Vaira LA, Colizza A, Cavaliere C, Laudani M, Frohman TC, De Vincentiis M, Frohman EM, Altieri M. Targeting Neuroinflammation to Alleviate Chronic Olfactory Dysfunction in Long COVID: A Role for Investigating Disease-Modifying Therapy (DMT)? Life (Basel) 2023; 13:226. [PMID: 36676175 PMCID: PMC9863729 DOI: 10.3390/life13010226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Chronic olfactory dysfunction after SARS-CoV-2 infection occurs in approximately 10% of patients with COVID-19-induced anosmia, and it is a growing public health concern. A regimen of olfactory training and anti-neuroinflammatory therapy with co-ultramicronized palmitoylethanolamide with luteolin (um-PEA-LUT) has shown promising results in clinical trials; however, approximately 15% of treated patients do not achieve full recovery of a normal olfactory threshold, and almost 5% have no recovery. Disease-modifying therapies (DMTs), which are used to treat autoimmune neuroinflammation in multiple sclerosis (MS), have not been studied for treating persistent inflammation in refractory post-COVID-19 smell disorder. This study evaluated COVID-19-related smell loss and MS-related smell loss, comparing the responses to different therapies. Forty patients with MS and 45 reporting post-COVID-19 olfactory disorders were included in the study. All patients underwent nasal endoscopy and were evaluated by using validated Sniffin' Sticks testing. The patients with long COVID were treated for three months with um-PEA-LUT plus olfactory training. The patients with MS were treated with DMTs. Olfactory functions before and after treatment were analyzed in both groups. At the experimental endpoint, 13 patients in the COVID-19 group treated with um-PEA-LUT had residual olfactory impairment versus 10 patients in the MS group treated with DMTs. The severity of the persistent olfactory loss was lower in the MS group, and the patients with MS treated with IFN-beta and glatiramer acetate had the preservation of olfactory function. These data provide a rationale for considering prospective trials investigating the efficacy of DMTs for post-COVID-19 olfactory disorders that are refractory to um-PEA-LUT with olfactory training. This study is the first to consider the role of DMT in treating refractory post-viral olfactory loss in patients with long COVID.
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Affiliation(s)
- Arianna Di Stadio
- GF Ingrassia Department, Otolaryngology, University of Catania, 95124 Catania, Italy
| | - Evanthia Bernitsas
- Multiple Sclerosis Center, Neurology Department, Wayne State University, Detroit, MI 48202, USA
| | - Ignazio La Mantia
- GF Ingrassia Department, Otolaryngology, University of Catania, 95124 Catania, Italy
| | - Michael J. Brenner
- Otolaryngology Department, Michigan University, Ann Arbor, MI 48109, USA
| | - Massimo Ralli
- Department of Sense Organs, La Sapienza University, 00185 Rome, Italy
| | - Luigi Angelo Vaira
- Oro-Maxillo-Facial Department, University of Sassari, 07100 Sassari, Italy
| | - Andrea Colizza
- Department of Sense Organs, La Sapienza University, 00185 Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, La Sapienza University, 00185 Rome, Italy
| | - Matteo Laudani
- Department of Neurology, University La Sapienza, 00185 Rome, Italy
| | - Teresa C. Frohman
- Distinguished Senior Fellows (Sabbatical), Laboratory of Neuroimmunology of Professor Lawrence Steinman, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Elliot M. Frohman
- Distinguished Senior Fellows (Sabbatical), Laboratory of Neuroimmunology of Professor Lawrence Steinman, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marta Altieri
- Department of Neurology, University La Sapienza, 00185 Rome, Italy
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10
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Sedighi S, Gholizadeh O, Yasamineh S, Akbarzadeh S, Amini P, Favakehi P, Afkhami H, Firouzi-Amandi A, Pahlevan D, Eslami M, Yousefi B, Poortahmasebi V, Dadashpour M. Comprehensive Investigations Relationship Between Viral Infections and Multiple Sclerosis Pathogenesis. Curr Microbiol 2023; 80:15. [PMID: 36459252 PMCID: PMC9716500 DOI: 10.1007/s00284-022-03112-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/05/2022] [Indexed: 12/04/2022]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (CNS). Compared to other types of self-limiting myelin disorders, MS compartmentalizes and maintains chronic inflammation in the CNS. Even though the exact cause of MS is unclear, it is assumed that genetic and environmental factors play an important role in susceptibility to this disease. The progression of MS is triggered by certain environmental factors, such as viral infections. The most important viruses that affect MS are Epstein-Barr virus (EBV), human herpes virus 6 (HHV-6), human endogenous retrovirus (HERV), cytomegalovirus (CMV), and varicella zoster virus (VZV). These viruses all have latent stages that allow them to escape immune detection and reactivate after exposure to various stimuli. Furthermore, their tropism for CNS and immune system cells explains their possible deleterious function in neuroinflammation. In this study, the effect of viral infections on MS disease focuses on the details of viruses that can change the risk of the disease. Paying attention to the most recent articles on the role of SARS-CoV-2 in MS disease, laboratory indicators show the interaction of the immune system with the virus. Also, strategies to prevent viruses that play a role in triggering MS are discussed, such as EBV, which is one of the most important.
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Affiliation(s)
- Somayeh Sedighi
- Department of Immunology, Faculty of Medicine, Medical Science of Mashhad, Mashhad, Iran
| | - Omid Gholizadeh
- Department of Bacteriology and Virology, Faculty of Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Yasamineh
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sama Akbarzadeh
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Parya Amini
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnia Favakehi
- Department of Microbiology, Falavargan Branch, Islamic Azad University, Isfahan, Iran
| | - Hamed Afkhami
- Department of Bacteriology, Faculty of Medicine, Medical Science of Shahed, Tehran, Iran
| | - Akram Firouzi-Amandi
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Daryoush Pahlevan
- Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Eslami
- Department of Bacteriology and Virology, Semnan University of Medical Sciences, Semnan, Iran
| | - Bahman Yousefi
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Vahdat Poortahmasebi
- Department of Bacteriology and Virology, Faculty of Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehdi Dadashpour
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.
- Department of Medical Biotechnology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
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11
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Almasi F, Mohammadipanah F. Neurological manifestations of SARS-CoV-2 infections: towards quantum dots based management approaches. J Drug Target 2023; 31:51-64. [PMID: 35921123 DOI: 10.1080/1061186x.2022.2110252] [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: 01/05/2023]
Abstract
Developing numerous nanotechnological designed tools to monitor the existence of SARS-CoV-2, and modifying its interactions address the global needs for efficient remedies required for the management of COVID-19. Herein, through a multidisciplinary outlook encompassing different fields such as the pathophysiology of SARS-CoV-2, analysis of symptoms, and statistics of neurological complications caused by SARS-CoV-2 infection in the central and peripheral nervous systems have been testified. The anosmia (51.1%) and ageusia (45.5%) are reported the most frequent neurological manifestation. Cerebrovascular disease and encephalopathy were mainly related to severe clinical cases. In addition, we focus especially on the various concerned physiological routes, including BBB dysfunction, which transpired due to SARS-CoV-2 infection, direct and indirect effects of the virus on the brain, and also, the plausible mechanisms of viral entry to the nerve system. We also outline the characterisation, and the ongoing pharmaceutical applications of quantum dots as smart nanocarriers crossing the blood-brain barrier and their importance in neurological diseases, mainly SARS-CoV-2 related manifestations Moreover, the market status, six clinical trials recruiting quantum dots, and the challenges limiting the clinical application of QDs are highlighted.
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Affiliation(s)
- Faezeh Almasi
- Pharmaceutical Biotechnology Lab, Department of Microbial Biotechnology, School of Biology and Center of Excellence in Phylogeny of Living Organisms, College of Science, University of Tehran, Tehran, Iran
| | - Fatemeh Mohammadipanah
- Pharmaceutical Biotechnology Lab, Department of Microbial Biotechnology, School of Biology and Center of Excellence in Phylogeny of Living Organisms, College of Science, University of Tehran, Tehran, Iran
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12
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Stamatellos VP, Papazisis G. Safety and Monitoring of the Treatment with Disease-Modifying Therapies (DMTs) for Multiple Sclerosis (MS). Curr Rev Clin Exp Pharmacol 2023; 18:39-50. [PMID: 35418296 DOI: 10.2174/2772432817666220412110720] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/08/2022] [Accepted: 01/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Disease-Modifying Therapies (DMTs) for Multiple Sclerosis (MS) are widely used given their proven efficacy in the relapsing form of the disease, while recently, Siponimod and Ocrelizumab have been approved for the progressive forms of the disease. Currently, 22 diseasemodifying drugs are approved by the FDA, while in 2012, only nine were present in the market. From March 2019 until August 2020, six new drugs were approved. This rapid development of new DMTs highlighted the need to update our knowledge about their short and long-term safety. OBJECTIVE This review summarizes the available safety data for all the Disease-Modifying Therapies for Multiple Sclerosis and presents the monitoring plan before and during the treatment. METHODS A literature search was conducted using PUBMED and COCHRANE databases. Key journals and abstracts from major annual meetings of Neurology, references of relevant reviews, and relative articles were also manually searched. We prioritized systematic reviews, large randomized controlled trials (RCTs), prospective cohort studies, and other observational studies. Special attention was paid to guidelines and papers focusing on the safety and monitoring of DMTs. CONCLUSION Data for oral (Sphingosine 1-phosphate (S1P) receptor modulators, Fumarates, Teriflunomide, Cladribine), injectables (Interferons, Glatiramer acetate, Ofatumumab), and infusion therapies (Natalizumab, Ocrelizumab, Alemtuzumab) are presented.
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Affiliation(s)
| | - Georgios Papazisis
- Clinical Trials Unit, Special Unit for Biomedical Research and Education & Department of Clinical Pharmacology School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Neurological disorders of COVID-19: insights to applications of natural products from plants and microorganisms. Arch Pharm Res 2022; 45:909-937. [PMCID: PMC9702705 DOI: 10.1007/s12272-022-01420-3] [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: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
In addition to the typical respiratory manifestations, various disorders including involvement of the nerve system have been detected in COVID-19 ranging from 22 to 36%. Although growing records are focusing on neurological aspects of COVID-19, the pathophysiological mechanisms and related therapeutic methods remain obscure. Considering the increased concerns of SARS-CoV-2 potential for more serious neuroinvasion conditions, the present review attempts to focus on the neuroprotective effects of natural compounds as the principle source of therapeutics inhibiting multiple steps of the SARS-CoV-2 infection cycle. The great majority of the natural products with anti-SARS-CoV-2 activity mainly inhibit the attachment, entry and gene expression rather than the replication, assembly, or release. Although microbial-derived natural products comprise 38.5% of the known natural products with neuroprotective effects following viral infection, the neuroprotective potential of the majority of microorganisms is still undiscovered. Among natural products, chrysin, huperzine A, ginsenoside Rg1, pterostilbene, and terrein have shown potent in vitro neuroprotective activity and can be promising for new or repurpose drugs for neurological complications of SARS-CoV-2.
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14
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Pandit L, Sudhir A, Malli C, D'Cunha A. COVID-19 infection and vaccination against COVID-19: Impact on managing demyelinating CNS disorders in Southern India- experience from a demyelinating disease registry. Mult Scler Relat Disord 2022; 66:104033. [PMID: 35849990 PMCID: PMC9252866 DOI: 10.1016/j.msard.2022.104033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVE The impact of COVID-19 infection and the effect of COVID-19 vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccination in order to develop management guidelines relevant to our patients. METHODS A total of 621 patients from our registry that included 297 MS and 324 non MS disorders (Aquaporin- 4 antibody positive [50], Myelin oligodendrocyte glycoprotein antibody positive [81], seronegative [162] and clinically isolated syndrome [31]) were contacted. COVID-19 infection and vaccination status were queried. Patients who self reported COVID-19 infection based on a positive RT PCR report were compared with non infected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. RESULTS Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 81 patients had mild infection and remained quarantined at home. All 13 patients who needed hospitalization recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. In univariate analysis, presence of ≥1 comorbidity was significantly associated with COVID-19 infection in both MS (p value 0.01, OR-2.28, 95%CI- 1.18-4.4) and non MS patients (p- 0.001, OR-4.4, 95% CI-1.88-10.24). In the latter, BMI ≥ 30 (p-0.04, OR-3.27, 95% CI- 0.98-10.87) and EDSS score ≥ 3 (p-0.02, OR- 2.59,95% CI- 1.08-6.23) were other significant associations. History of prior COVID-19 vaccination was associated with reduced frequency of COVID-19 infection among MS (p- 0.001,OR- 0.24,95% CI- 0.13-0.43) and non MS patients (p- 0.0001,OR-0.14, 95% CI- 0.058-0.35). In multivariate analysis presence of comorbidities significantly increased and prior vaccination significantly reduced frequency of COVID-19 infection for both MS and related disorders. Concurrent disease modifying treatments showed a trend for association with infection. In the unvaccinated group, patients on disease modifying treatment were significantly at risk of infection, 81.5% unvaccinated and treated versus 18.5% who were unvaccinated and untreated (p- 0.0001, OR-10.1, 95% CI-0.56-2.11). CONCLUSION Frequency and severity of COVID-19 infection was low among our patient cohort. Higher rate of infection in the treated group was significantly seen among unvaccinated patients. Our preliminary results suggests that in LMIC's, where "off label therapies" with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and effective against severe COVID-19 infection.
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Affiliation(s)
- L Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India.
| | - A Sudhir
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India
| | - C Malli
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India
| | - A D'Cunha
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India
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15
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Barzegar M, Houshi S, Sadeghi E, Hashemi MS, Pishgahi G, Bagherieh S, Afshari-Safavi A, Mirmosayyeb O, Shaygannejad V, Zabeti A. Association of Disease-Modifying Therapies with COVID-19 Susceptibility and Severity in Patients with Multiple Sclerosis: A Systematic Review and Network Meta-Analysis. Mult Scler Int 2022; 2022:9388813. [PMID: 36187599 PMCID: PMC9519336 DOI: 10.1155/2022/9388813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background We conducted this study to assess the effect of disease-modifying therapies (DMTs) on coronavirus disease (COVID-19) susceptibility and severity in people with multiple sclerosis (MS). Methods Available studies from PubMed, Scopus, EMBASE, Web of Science, and gray literature, including reference lists and conference abstracts, were searched from December 1, 2019, to July 26, 2021. We included cross-sectional, case-control, and cohort studies assessing the association of DMTs with risk of contracting COVID-19 or its outcomes in MS patients on univariate or multivariate regression analyses. We conducted a network meta-analysis (NMA) to compare the risk of COVID-19 and developing severe infection across DMTs. Results Out of the initial 3893 records and 1883 conference abstracts, a total of 10 studies were included. Pairwise comparisons showed that none of the DMTs meaningfully affect the risk of acquiring infection. There was significant total heterogeneity and inconsistency across this NMA. In comparison with no DMT, dimethyl fumarate (0.62 (0.42, 0.93)), fingolimod (0.55 (0.32, 0.94)), natalizumab (0.50 (0.31, 0.81)), and interferon (0.42 (0.22, 0.79)) were associated with a decreased risk of severe COVID-19; but, rituximab was observed to increase the risk (1.94 (1.20, 3.12)). Compared to rituximab or ocrelizumab, all DMTs were associated with a decreased risk. Pairwise comparisons showed no differences across other DMTs. Interferon and rituximab were associated with the lowest and highest risks of severe COVID-19. Conclusion Our study showed an increased risk of severe COVID-19 in patients on rituximab and ocrelizumab. No association with COVID-19 severity across other DMTs was observed.
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Affiliation(s)
- Mahdi Barzegar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shakiba Houshi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sadeghi
- Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozhgan Sadat Hashemi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Pishgahi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Bagherieh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aram Zabeti
- Department of Neurology and Rehabilitation Medicine, Waddell center in Multiple Sclerosis, University of Cincinnati, Cincinnati, OH, USA
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16
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Kim E, Haag A, Nguyen J, Kesselman MM, Demory Beckler M. Vaccination of multiple sclerosis patients during the COVID-19 era: Novel insights into vaccine safety and immunogenicity. Mult Scler Relat Disord 2022; 67:104172. [PMID: 36116380 PMCID: PMC9462931 DOI: 10.1016/j.msard.2022.104172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/13/2022] [Accepted: 09/08/2022] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) is an incurable autoimmune disease known to cause widespread demyelinating lesions in the central nervous system (CNS) and a host of debilitating symptoms in patients. The development of MS is believed to be driven by the breakdown of the blood brain barrier, subsequent infiltration by CD4+ and CD8+ T cells, and widespread CNS inflammation and demyelination. Disease modifying therapies (DMTs) profoundly disrupt these processes and therefore compose an essential component of disease management. However, the effects of these therapeutic agents on vaccine safety and immunogenicity in individuals with MS are not yet fully understood. As such, the primary objective of this review article was to summarize the findings of recently conducted studies on vaccine safety and immunogenicity in MS patients treated with DMTs, particularly in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Discussed in this review are vaccinations against influenza, yellow fever, human papillomavirus, measles, mumps, rubella, Streptococcus pneumoniae, hepatitis B, and COVID-19. This article additionally reviews our current understanding of COVID-19 severity and incidence in this patient population, the risks and benefits of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and vaccination guidelines set forth by MS societies and organizations.
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Affiliation(s)
- Enoch Kim
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Alyssa Haag
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Jackie Nguyen
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Marc M Kesselman
- Division of Rheumatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Michelle Demory Beckler
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
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Meca-Lallana V, García Domínguez JM, López Ruiz R, Martín-Martínez J, Arés Luque A, Hernández Pérez MA, Prieto González JM, Landete Pascual L, Sastre-Garriga J. Expert-Agreed Practical Recommendations on the Use of Cladribine. Neurol Ther 2022; 11:1475-1488. [PMID: 36068429 PMCID: PMC9447968 DOI: 10.1007/s40120-022-00394-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/03/2022] [Indexed: 12/13/2022] Open
Abstract
Cladribine is a disease-modifying selective immune reconstitution oral therapy for adult patients with highly active relapsing multiple sclerosis (RMS). It was approved in the USA in 2019 and in Europe in 2017, thus there are still gaps in existing guidelines for using cladribine tablets in clinical practice. Nine experts with extensive experience in managing patients with multiple sclerosis in Spain identified some of the unanswered questions related to the real-life use of cladribine tablets. They reviewed the available clinical trial data and real-world evidence, including their own experiences of using cladribine, over the course of three virtual meetings held between November 2020 and January 2021. This article gathers their practical recommendations to aid treatment decision-making and optimise the use of cladribine tablets in patients with RMS. The consensus recommendations cover the following areas: candidate patient profiles, switching strategies (to and from cladribine), managing response to cladribine and safety considerations.
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Affiliation(s)
- Virginia Meca-Lallana
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario "La Princesa", Madrid, Spain.
| | | | - Rocío López Ruiz
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Adrián Arés Luque
- Neurology Department, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | - Jaume Sastre-Garriga
- Neurology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Muñoz-Jurado A, Escribano BM, Agüera E, Caballero-Villarraso J, Galván A, Túnez I. SARS-CoV-2 infection in multiple sclerosis patients: interaction with treatments, adjuvant therapies, and vaccines against COVID-19. J Neurol 2022; 269:4581-4603. [PMID: 35788744 PMCID: PMC9253265 DOI: 10.1007/s00415-022-11237-1] [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: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 12/12/2022]
Abstract
The SARS-CoV-2 pandemic has raised particular concern for people with Multiple Sclerosis, as these people are believed to be at increased risk of infection, especially those being treated with disease-modifying therapies. Therefore, the objective of this review was to describe how COVID-19 affects people who suffer from Multiple Sclerosis, evaluating the risk they have of suffering an infection by this virus, according to the therapy to which they are subjected as well as the immune response of these patients both to infection and vaccines and the neurological consequences that the virus can have in the long term. The results regarding the increased risk of infection due to treatment are contradictory. B-cell depletion therapies may cause patients to have a lower probability of generating a detectable neutralizing antibody titer. However, more studies are needed to help understand how this virus works, paying special attention to long COVID and the neurological symptoms that it causes.
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Affiliation(s)
- Ana Muñoz-Jurado
- Department of Cell Biology, Physiology and Immunology, Faculty of Veterinary Medicine, University of Cordoba, Campus of Rabanales, 14071 Cordoba, Spain
| | - Begoña M. Escribano
- Department of Cell Biology, Physiology and Immunology, Faculty of Veterinary Medicine, University of Cordoba, Campus of Rabanales, 14071 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
| | - Eduardo Agüera
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Neurology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Javier Caballero-Villarraso
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, 14004 Cordoba, Spain
- Clinical Analysis Service, Reina Sofía University Hospital, Cordoba, Spain
| | - Alberto Galván
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, 14004 Cordoba, Spain
| | - Isaac Túnez
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, 14004 Cordoba, Spain
- Cooperative Research Thematic Excellent Network on Brain Stimulation (REDESTIM), Madrid, Spain
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19
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The disease course of multiple sclerosis before and during COVID-19 pandemic: A retrospective five-year study. Mult Scler Relat Disord 2022; 65:103985. [PMID: 35759904 PMCID: PMC9212895 DOI: 10.1016/j.msard.2022.103985] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 01/13/2023]
Abstract
Introduction COVID-19 pandemic is thought to influence the natural history of immune disorders, yet the knowledge on its effect on multiple sclerosis (MS) is unknown and not fully understood for which we conducted this retrospective study. Methods and materials We included all patients with MS seen in King Faisal Specialist Hospital and Research Centre in Jeddah, Saudi Arabia, between January 2017 and October 20201. We determined clinical and radiological evidence of disease activities in all patients by the end of the study period, and we compared the disease patterns before and during the pandemic. We also identified patients with COVID-19 since March 2020, who had at least 3 months of follow-up following the infection. Results We studied 301 patients; 216 (72%) were women, the mean age was 38 years (range; 16, 73 years), the mean disease duration was 10 years (range; 1, 36 years), and the median EDSS score was 0.5 (range; 0, 8). RRMS accounted for most of the cases (270 patients). MS disease activities were 25% less prevalent during the pandemic compared to the preceding 3 years (26 vs. 51%, respectively, p < 0.01). Bivariate analysis showed significant higher disease activities in patients younger than 35 years (73 vs 27%), on DMT (68 vs 32%), and complaint to therapy (69 vs 31%). Multiple logistic regression analysis showed that the likelihood of MS disease activities were 3 times more during the pre-pandemic era (adjusted OR = 3.1, p value < 0.05, 95% CI; 1.4, 7.1). Thirty patients (10%) were infected with COVID-19. All patients reported mild symptoms, and none required hospitalization. COVID-19 was prevalent among younger patients with RRMS, with low EDSS scores, irrespective of DMTs they received. COVID-19 infection was not associated with clinical relapses or MRI changes. Disease activities were dependent on DMT use and not COVID-19 status. Multivariate analyses also confirmed no effect of COVID-19 on disease activities (p = 0.3 and 0.4, for clinical and MRI changes, respectively). Conclusions MS disease activities did not increase during the pandemic, yet the apparent decrease in the disease activities is probably due to under reporting and not a real decrease in disease activities because of the pandemic. The COVID-19 infection in our MS patients showed a benign disease course, yet standard precautions to reduce the risk of COVID-19 transmission should be applied accordingly.
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Abstract
Purpose of Review COVID-19 has posed a continuously evolving challenge for providers caring for patients with multiple sclerosis (MS). While guidelines from national and international organizations came quickly, these have required constant reassessment and modification as the pandemic has progressed. This review aims to assess the first 2 years of literature on COVID-19 relevant to the clinical management of patients with MS. In particular, we will review how MS impacts the risk of COVID-19 infection, how disease-modifying therapies may alter this risk, and explore considerations regarding disease-modifying therapy (DMT) and vaccination for COVID-19. We will also explore potential ways in which a COVID-19 infection may impact multiple sclerosis. Our goal is to provide an overarching review of the major findings at this stage of the pandemic relevant to those that care for patients with MS. Recent Findings Over the course of the COVID-19 pandemic, providers have had to re-evaluate the priorities in the management of MS. A growing number of studies have evaluated the relevant risk factors and considerations regarding MS and particular disease-modifying therapies. Summary The long-term impacts of the pandemic on the health of those with MS will continue to be revealed. In general, most patients with MS do not need major revisions to their treatment plan due to COVID-19 risk. However, individuals who are older, more disabled, and on more potent therapies may need to consider strategies for decreasing their overall risk. Regardless, continued improvement in our understanding of interactions between infections, disease-modifying therapy, and MS are paramount to optimizing the care of those with MS going forward.
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21
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Sancho-Saldaña A, Gil Sánchez A, Quirant-Sánchez B, Nogueras L, Peralta S, Solana MJ, González-Mingot C, Gallego Y, Quibus L, Ramo-Tello C, Presas-Rodríguez S, Martínez-Cáceres E, Torres P, Hervás JV, Valls J, Brieva L. Seroprevalence of SARS-CoV-2 in a Cohort of Patients with Multiple Sclerosis under Disease-Modifying Therapies. J Clin Med 2022; 11:2509. [PMID: 35566632 PMCID: PMC9099725 DOI: 10.3390/jcm11092509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) alter the immune system and therefore increase the risk of infection. There is growing concern about the impact of COVID-19 on patients with MS (pwMS), especially those treated with DMTs. Methods: This is a single-center prospective observational study based on data from the Esclerosis Múltiple y COVID-19 (EMCOVID-19) study. Demographic characteristics, MS history, laboratory data and SARS-CoV-2 serology, and symptoms of COVID-19 in pwMS treated with any DTM were extracted. The relationship among demographics, MS status, DMT, and COVID-19 was evaluated. Results: A total of 259 pwMS were included. The administration of interferon was significantly associated with the presence of SARS-CoV-2 antibodies (26.4% vs. 10.7%, p = 0.006). Although patients taking interferon were significantly older (49.1 vs. 43.5, p = 0.003), the association of interferon with the presence of SARS-CoV-2 antibodies was still significant in the multivariate analysis (OR 2.99 (1.38; 6.36), p = 0.006). Conclusions: According to our data, pwMS present a higher risk of COVID-19 infection compared with results obtained from the general population. There is no evidence of a worse COVID-19 outcome in pwMS. DMTs did not significantly change the frequency of COVID-19, except for interferon; however, these findings must be interpreted with caution given the small sample of pwMS taking each DMT.
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Affiliation(s)
- Agustín Sancho-Saldaña
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Anna Gil Sánchez
- Neuroimmunology Group, Institut de Recerca Biomèdica, Universitat de Lleida, 25001 Lleida, Spain; (A.G.S.); (L.N.); (P.T.)
| | - Bibiana Quirant-Sánchez
- Immunology Division, Hospital Germans Trias i Pujol, LCMN, 08916 Badalona, Spain; (B.Q.-S.); (E.M.-C.)
- Department of Cell Biology, Physiology, Immunology, Autonomous University, Bellaterra, 08193 Barcelona, Spain
| | - Lara Nogueras
- Neuroimmunology Group, Institut de Recerca Biomèdica, Universitat de Lleida, 25001 Lleida, Spain; (A.G.S.); (L.N.); (P.T.)
| | - Silvia Peralta
- Multiple Sclerosis Foundation from Lleida, 25198 Lleida, Spain;
| | - Maria José Solana
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Cristina González-Mingot
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Yhovanni Gallego
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Laura Quibus
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Cristina Ramo-Tello
- Multiple Sclerosis and Clinical Neuroimmunology Unit, Neurosciences Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (C.R.-T.); (S.P.-R.)
| | - Silvia Presas-Rodríguez
- Multiple Sclerosis and Clinical Neuroimmunology Unit, Neurosciences Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (C.R.-T.); (S.P.-R.)
| | - Eva Martínez-Cáceres
- Immunology Division, Hospital Germans Trias i Pujol, LCMN, 08916 Badalona, Spain; (B.Q.-S.); (E.M.-C.)
- Department of Cell Biology, Physiology, Immunology, Autonomous University, Bellaterra, 08193 Barcelona, Spain
| | - Pascual Torres
- Neuroimmunology Group, Institut de Recerca Biomèdica, Universitat de Lleida, 25001 Lleida, Spain; (A.G.S.); (L.N.); (P.T.)
| | | | - Joan Valls
- Biostatistics Group, Institut de Recerca Biomèdica de Lleida, 25198 Lleida, Spain;
| | - Luis Brieva
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
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22
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Razi O, Tartibian B, Laher I, Govindasamy K, Zamani N, Rocha-Rodrigues S, Suzuki K, Zouhal H. Multimodal Benefits of Exercise in Patients With Multiple Sclerosis and COVID-19. Front Physiol 2022; 13:783251. [PMID: 35492581 PMCID: PMC9048028 DOI: 10.3389/fphys.2022.783251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease characterized by plaque formation and neuroinflammation. The plaques can present in various locations, causing a variety of clinical symptoms in patients with MS. Coronavirus disease-2019 (COVID-19) is also associated with systemic inflammation and a cytokine storm which can cause plaque formation in several areas of the brain. These concurring events could exacerbate the disease burden of MS. We review the neuro-invasive properties of SARS-CoV-2 and the possible pathways for the entry of the virus into the central nervous system (CNS). Complications due to this viral infection are similar to those occurring in patients with MS. Conditions related to MS which make patients more susceptible to viral infection include inflammatory status, blood-brain barrier (BBB) permeability, function of CNS cells, and plaque formation. There are also psychoneurological and mood disorders associated with both MS and COVID-19 infections. Finally, we discuss the effects of exercise on peripheral and central inflammation, BBB integrity, glia and neural cells, and remyelination. We conclude that moderate exercise training prior or after infection with SARS-CoV-2 can produce health benefits in patients with MS patients, including reduced mortality and improved physical and mental health of patients with MS.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Bakhtyar Tartibian
- Department of Sports Injuries, Faculty of Physical Education and Sports Sciences, Allameh Tabataba’i University, Tehran, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karuppasamy Govindasamy
- Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, India
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Silvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), Quinta de Prados, Edifício Ciências de Desporto, Vila Real, Portugal
- Tumor & Microenvironment Interactions Group, i3S, Porto, Portugal
| | | | - Hassane Zouhal
- Laboratoire Mouvement, Sport, Santé, University of Rennes, Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
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23
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Abstract
Neuroimmunological diseases and their treatment compromise the immune system, thereby increasing the risk of infections and serious illness. Consequently, vaccinations to protect against infections are an important part of the clinical management of these diseases. However, the wide variety of immunotherapies that are currently used to treat neuroimmunological disease — particularly multiple sclerosis and neuromyelitis optica spectrum disorders — can also impair immunological responses to vaccinations. In this Review, we discuss what is known about the effects of various immunotherapies on immunological responses to vaccines and what these effects mean for the safe and effective use of vaccines in patients with a neuroimmunological disease. The success of vaccination in patients receiving immunotherapy largely depends on the specific mode of action of the immunotherapy. To minimize the risk of infection when using immunotherapy, assessment of immune status and exclusion of underlying chronic infections before initiation of therapy are essential. Selection of the required vaccinations and leaving appropriate time intervals between vaccination and administration of immunotherapy can help to safeguard patients. We also discuss the rapidly evolving knowledge of how immunotherapies affect responses to SARS-CoV-2 vaccines and how these effects should influence the management of patients on these therapies during the COVID-19 pandemic. In this Review, the authors discuss how various immunotherapies for neuroimmunological diseases interact with vaccination responses, including responses to SARS-CoV-2 vaccinations, and the implications for the safe and effective use of vaccines in patients with these diseases. Vaccination against infection is an essential part of the management of neuroimmunological diseases. All indicated vaccinations should be administered before initiation of immunotherapy whenever possible; appropriate intervals between vaccination and treatment vary with treatment and vaccination. Inactivated vaccines are considered safe in neuroimmunological diseases but live vaccines are generally contraindicated during immunotherapy. Vaccination responses during immunotherapy can be diminished or abrogated, depending on the treatment and vaccination; antibody titre testing to monitor responses can be considered where appropriate. Vaccinations must be avoided during relapses or exacerbations of neuroimmunological diseases. Vaccination against SARS-CoV-2 is recommended for patients with neuroimmunological disease but some immunotherapies limit the immune response; therefore, timing should be considered carefully.
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24
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Brunn JA, Dunietz GL, Romeo AR, Braley TJ. SARS-CoV-2 Infection and Vaccination Outcomes in Multiple Sclerosis. Neurol Clin Pract 2022; 12:e14-e21. [DOI: 10.1212/cpj.0000000000001164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/09/2022] [Indexed: 11/15/2022]
Abstract
Abstract:Background:The effects of the SARs-CoV-2 vaccination and infection on clinical outcomes, including relapse risk, have been insufficiently explored in people with MS (PwMS). The objectives of this study were to determine the incidence of new neurologic symptoms or symptom recrudescence among PwMS who received the SARs-CoV-2 vaccine, characterize outcomes following SARs-CoV-2 infection, and assess MS-specific determinants of vaccine hesitancy.Methods:Online surveys that assessed incidence and severity of SARs-CoV-2 infection, vaccination status/type, reasons for vaccine deferral, and post-vaccination symptoms were administered to PwMS. Medical charts were reviewed for consenting respondents. Associations between infection, post-vaccination outcomes, and clinical characteristics were compared using chi-square tests, 2-sample T-tests, and adjusted logistic regression models.Results:n=292 of 333 respondents were vaccinated, of which 58% reported post-vaccination side effects, most commonly among mRNA vaccine recipients (p=0.02), younger patients (p<0.01), and relapsing-remitting MS (p=0.03). Twelve percent endorsed recrudescence of existing MS symptoms, while 3% endorsed new neurologic symptoms post-vaccination. N=62 reported SARs-CoV-2 infection since the start of the pandemic, more frequent in younger individuals (1-year OR=0.958, 10-year OR=0.649, p<0.01). Neither DMT nor B-cell therapies specifically were associated with vaccine side effects, neurologic symptoms, or SARs-CoV-2 infection. Twenty-one percent of unvaccinated cited a desire for provider guidance prior to vaccination.Conclusion:Our findings provide new data to suggest that among PwMS who received SARs-CoV-2 vaccination, clinical disease worsening is rare and mostly associated with symptom recrudescence, as opposed to new relapses. Post-vaccination side effects may occur more often among mRNA vaccine recipients, and in younger individuals.
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Tornatore C, Wiendl H, Lublin AL, Geertsen SS, Chavin J, Truffinet P, Bar-Or A. Vaccine Response in Patients With Multiple Sclerosis Receiving Teriflunomide. Front Neurol 2022; 13:828616. [PMID: 35295832 PMCID: PMC8918991 DOI: 10.3389/fneur.2022.828616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/17/2022] [Indexed: 12/18/2022] Open
Abstract
Many patients with multiple sclerosis (MS) receive disease-modifying therapies (DMTs), such as teriflunomide, to reduce disease activity and slow progression. DMTs mediate their efficacy by modulating or suppressing the immune system, which might affect a patient's response to vaccination. As vaccines against the SARS-CoV-2 virus become available, questions have arisen around their efficacy and safety for patients with MS who are receiving DMTs. Data are beginning to emerge regarding the potential influence of certain DMTs on a patient's response to coronavirus disease 2019 (COVID-19) vaccines and are supported by evidence from vaccination studies of other pathogens. This review summarizes the available data on the response to vaccines in patients with MS who are receiving DMTs, with a focus on teriflunomide. It also provides an overview of the leading COVID-19 vaccines and current guidance around COVID-19 vaccination for patients with MS. Though few vaccination studies have been done for this patient population, teriflunomide appears to have minimal influence on the response to seasonal influenza vaccine. The evidence for other DMTs (e.g., fingolimod, glatiramer acetate) is less consistent: some studies suggest no effect of DMTs on vaccine response, whereas others show reduced vaccine efficacy. No unexpected safety signals have emerged in any vaccine study. Current guidance for patients with MS is to continue DMTs during COVID-19 vaccination, though adjusted timing of dosing for some DMTs may improve the vaccine response.
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Affiliation(s)
- Carlo Tornatore
- Georgetown University Hospital, Washington, DC, United States
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | | | | | | | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
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Olivé-Cirera G, Fonseca E, Cantarín-Extremera V, Vázquez-López M, Jiménez-Legido M, González-Álvarez V, Ribeiro-Constante J, Camacho-Salas A, Martí I, Cancho-Candela R, Martínez-González MJ, Saiz A, Armangué T. Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:e1101. [PMID: 34759018 PMCID: PMC8587734 DOI: 10.1212/nxi.0000000000001101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic. METHODS Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded. RESULTS One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8-16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], p = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 (p < 0.001) and lower blood levels of vitamin D (p = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change. DISCUSSION In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.
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Affiliation(s)
- Gemma Olivé-Cirera
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Elianet Fonseca
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Verónica Cantarín-Extremera
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Vázquez-López
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Jiménez-Legido
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Verónica González-Álvarez
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Juliana Ribeiro-Constante
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Ana Camacho-Salas
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Itxaso Martí
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Ramon Cancho-Candela
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - María Jesús Martínez-González
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Albert Saiz
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
| | - Thaís Armangué
- From the Pediatric Neuroimmunology Program (G.O.-C.,E.F.,A.S.,T.A.), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona; Pediatric Neurology Unit of Parc Taulí Hospital of Sabadell (G.O.-C.), Barcelona; Pediatric Neurology Unit of Hospital Infantil Universitario Niño Jesús (V.C.-E.,M.J.-L.), Madrid; Pediatric Neurology Unit of Hospital Gregorio Marañón (M.V.-L.), Madrid; Pediatric Neuroimmunology Unit (V.G.-A.,J.R.-C.,T.A.), Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona; Pediatric Neurology Unit of Hospital Universitario 12 de Octubre, Complutense University of Madrid (A.C.S.); Pediatric Neurology Unit of Hospital Universitario Donostia (I.M.), Guipuzcoa; Pediatric Neurology Unit of Hospital Universitario Río Hortega (R.C.-C.), Valladolid; and Pediatric Neurology Unit of Cruces University Hospital (M.J.M.-G.), Bilbao, Spain
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Razi O, Tartibian B, Teixeira AM, Zamani N, Govindasamy K, Suzuki K, Laher I, Zouhal H. Thermal dysregulation in patients with multiple sclerosis during SARS-CoV-2 infection. The potential therapeutic role of exercise. Mult Scler Relat Disord 2022; 59:103557. [PMID: 35092946 PMCID: PMC8785368 DOI: 10.1016/j.msard.2022.103557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 12/15/2022]
Abstract
Thermoregulation is a homeostatic mechanism that is disrupted in some neurological diseases. Patients with multiple sclerosis (MS) are susceptible to increases in body temperature, especially with more severe neurological signs. This condition can become intolerable when these patients suffer febrile infections such as coronavirus disease-2019 (COVID-19). We review the mechanisms of hyperthermia in patients with MS, and they may encounter when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Finally, the thermoregulatory role and relevant adaptation to regular physical exercise are summarized.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Bakhtyar Tartibian
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Ana Maria Teixeira
- University of Coimbra, Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Karuppasamy Govindasamy
- Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan.
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Santé) - EA 1274, Rennes F-35000, France; Institut International des Sciences du Sport (2I2S), Irodouer 35850, France.
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Portaccio E, Fonderico M, Hemmer B, Derfuss T, Stankoff B, Selmaj K, Tintorè M, Amato MP. Impact of COVID-19 on multiple sclerosis care and management: Results from the European Committee for Treatment and Research in Multiple Sclerosis survey. Mult Scler 2022; 28:132-138. [PMID: 33764197 PMCID: PMC8689421 DOI: 10.1177/13524585211005339] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The spread of Coronavirus disease-19 (COVID-19) poses unique challenges in the management of people with multiple sclerosis (PwMS). OBJECTIVES To collect data about the impact of COVID-19 emergency on access to care for PwMS and on MS treatment practices. METHODS Between March and July 2020, the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) promoted an online survey covering patient access to care, management of relapses and visits, disease-modifying therapy (DMT) and experience with COVID-19. RESULTS Three-hundred and sixty neurologists from 52 countries (68% from Europe) completed the survey. 98% reported COVID-19-related restrictions. Telemedicine was adopted to overcome the limited access to care and was newly activated (73%) or widely implemented (17%). 70% reported changes in DMT management. Interferons and glatiramer were considered safe. Dimethyl fumarate, teriflunomide and fingolimod were considered safe except for patients developing lymphopenia. No modifications were considered for natalizumab in 64%, cladribine in 24%, anti-CD20 in 22% and alemtuzumab in 17%; 18% (for alemtuzumab and cladribine) and 43% (for anti-CD20) considered postponing treatment. CONCLUSION The ECTRIMS survey highlighted the challenges in keeping standards of care in clinical practice. Telemedicine clearly needs to be implemented. Gathering data on DMT safety will remain crucial to inform treatment decisions.
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Affiliation(s)
| | - Mattia Fonderico
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Bernhard Hemmer
- Neurology Department, Klinikum rechts der Isar TU München, Münich, Germany/Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital of Basel, Basel, Switzerland
| | - Bruno Stankoff
- Department of Neurology, ICM, Hôpital Pitié Salpêtrière, Paris, France
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Mar Tintorè
- Department of the Neurology/Neuroimmunology and Research Institute Barcelona, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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29
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Bsteh G, Dürauer S, Assar H, Hegen H, Heschl B, Leutmezer F, Pauli FD, Gradl C, Traxler G, Zulehner G, Rommer P, Wipfler P, Guger M, Höftberger R, Enzinger C, Berger T. Humoral immune response after COVID-19 in multiple sclerosis: A nation-wide Austrian study. Mult Scler 2021; 27:2209-2218. [PMID: 34595968 PMCID: PMC8597187 DOI: 10.1177/13524585211049391] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Knowledge on immunity after SARS-CoV-2 infection in patients with multiple sclerosis (pwMS) and the impact of disease-modifying treatment (DMT) is limited. OBJECTIVE To evaluate degree, duration and potential predictors of specific humoral immune response in pwMS with prior COVID-19. METHODS Anti-SARS-CoV-2 antibody testing was performed in pwMS with PCR-confirmed diagnosis of symptomatic COVID-19 from a nation-wide registry. Predictors of seropositivity were identified by multivariate regression models. RESULTS In 125 pwMS (mean age = 42.4 years (SD = 12.3 years), 70% female), anti-SARS-CoV-2 antibodies were detected in 76.0% after a median of 5.2 months from positive PCR. Seropositivity rate was significantly lower in patients on IS-DMT (61.4%, p = 0.001) than without DMT or immunomodulatory DMT (80.6%; 86.0%, respectively). In multivariate analysis, IS-DMT was associated with reduced probability of seropositivity (odds ratio (OR): 0.51; 95% confidence interval (95% CI): 0.17-0.82; p < 0.001). Predefined subgroup analyses showed marked reduction of seropositivity in pwMS on rituximab/ocrelizumab (OR 0.15; 95% CI: 0.05-0.56; p < 0.001). Rate of seropositivity did not change significantly over 6 months. CONCLUSIONS Humoral immunity is stable after SARS-CoV-2 infection in MS, but is reduced by immunosuppressive DMT, particularly anti-CD20 monoclonal antibodies. This provides important evidence for advising pwMS as well as for planning and prioritizing vaccination.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sophie Dürauer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hamid Assar
- Department of Neurology, Kepler University Hospital, Linz, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Heschl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christiane Gradl
- Department of Neurology, Medical University of St. Pölten, St. Pölten, Austria
| | - Gerhard Traxler
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Wipfler
- Department of Neurology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Toscano S, Chisari CG, Patti F. Multiple Sclerosis, COVID-19 and Vaccines: Making the Point. Neurol Ther 2021; 10:627-649. [PMID: 34625925 PMCID: PMC8500471 DOI: 10.1007/s40120-021-00288-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
On 11 March 2020, the World Health Organization declared the coronavirus disease 19 (COVID-19) outbreak a pandemic. In this context, several studies and clinical trials have been conducted since then, and many are currently ongoing, leading to the development of several COVID-19 vaccines with different mechanisms of action. People affected by multiple sclerosis (MS) have been considered high-risk subjects in most countries and prioritized for COVID-19 vaccination. However, the management of MS during the COVID-19 pandemic has represented a new challenge for MS specialists, particularly because of the initial lack of guidelines and differing recommendations. Despite an initial hesitation in prescribing disease-modifying drugs (DMDs) in naïve and already treated patients with MS, most national neurology associations and organizations agree on not stopping treatment. However, care is needed especially for patients treated with immune-depleting drugs, which also require some attentions in programming vaccine administration. Many discoveries and new research results have accumulated in a short time on COVID-19, resulting in a need for summarizing the existing evidence on this topic. In this review, we describe the latest research results on the immunological aspects of SARS-CoV-2 infection speculating about their impact on COVID-19 vaccines' mechanisms of action and focused on the management of MS during the COVID pandemic according to the most recent guidelines and recommendations. Finally, the efficacy of COVID-19 and other well-known vaccines against infectious disease in patients with MS on DMDs is discussed.
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Affiliation(s)
- Simona Toscano
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Clara G Chisari
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Patti
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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31
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Etemadifar M, Sami R, Salari M, Sedaghat N, Sigari AA, Aghababaei A, Najafi M, Tehrani DS. Outcome of COVID-19 infection in multiple sclerosis patients receiving disease-modifying therapies. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:85. [PMID: 34760002 PMCID: PMC8548892 DOI: 10.4103/jrms.jrms_1047_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/15/2020] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
Background With the spread of COVID-19, treatment of diseases such as multiple sclerosis (MS) should be resumed with caution due to the disease-modifying therapies (DMTs) used in this subset of patients and the immunoregulatory effects of these drugs. We aim to assess the outcome of COVID-19 infection in MS patients receiving DMTs. Materials and Methods This is a cross-sectional study involving 45 COVID-19-infected patients previously diagnosed with MS. The data regarding their MS status and the type of DMT taken by the patients were extracted from the Isfahan MS Institute registry and were summarized. Diagnosis of MS was based on the 2017 McDonald Criteria, and the diagnosis of COVID-19 was based on computed tomography scan and polymerase chain reaction of nasopharyngeal swabs. Results Out of the 45 MS patients infected with COVID-19, 5 had unfavorable outcomes. Two patients deceased and the other three had persistent respiratory complications on the 4-week follow-up visit. Hypertension, diabetes, seizures, and rheumatoid arthritis were among the comorbidities that the patients reported. Both patients who died received rituximab as part of their MS treatment. All other patients recovered completely. Conclusion Each different drug category may possess a distinct risk for infection, therefore until robust evidence are available, the safest drug should be utilized or the therapy should be postponed, if possible, to minimize patient risk. Disease-modifying therapy use in MS patients should be cautiously applied as their effect on COVID-19 infection prognosis is not yet studied.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurosurgery, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Sami
- Department of Internal Medicine, Khorshid University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Department of Neurology, Shahid Beheshti University, Tehran, Iran
| | - Nahad Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Akhavan Sigari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Aghababaei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Najafi
- Department of Neurology, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Özkeskin M, Özden F, Karaman B, Ekmekçi Ö, Yüceyar N. The comparison of fatigue, sleep quality, physical activity, quality of life, and psychological status in multiple sclerosis patients with or without COVID-19. Mult Scler Relat Disord 2021; 55:103180. [DOI: https:/doi.org/10.1016/j.msard.2021.103180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Karnik M, Beeraka NM, Uthaiah CA, Nataraj SM, Bettadapura ADS, Aliev G, Madhunapantula SV. A Review on SARS-CoV-2-Induced Neuroinflammation, Neurodevelopmental Complications, and Recent Updates on the Vaccine Development. Mol Neurobiol 2021; 58:4535-4563. [PMID: 34089508 PMCID: PMC8179092 DOI: 10.1007/s12035-021-02399-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/19/2021] [Indexed: 02/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a devastating viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The incidence and mortality of COVID-19 patients have been increasing at an alarming rate. The mortality is much higher in older individuals, especially the ones suffering from respiratory distress, cardiac abnormalities, renal diseases, diabetes, and hypertension. Existing evidence demonstrated that SARS-CoV-2 makes its entry into human cells through angiotensin-converting enzyme 2 (ACE-2) followed by the uptake of virions through cathepsin L or transmembrane protease serine 2 (TMPRSS2). SARS-CoV-2-mediated abnormalities in particular cardiovascular and neurological ones and the damaged coagulation systems require extensive research to develop better therapeutic modalities. As SARS-CoV-2 uses its S-protein to enter into the host cells of several organs, the S-protein of the virus is considered as the ideal target to develop a potential vaccine. In this review, we have attempted to highlight the landmark discoveries that lead to the development of various vaccines that are currently under different stages of clinical progression. Besides, a brief account of various drug candidates that are being tested to mitigate the burden of COVID-19 was also covered. Further, in a dedicated section, the impact of SARS-CoV-2 infection on neuronal inflammation and neuronal disorders was discussed. In summary, it is expected that the content covered in this article help to understand the pathophysiology of COVID-19 and the impact on neuronal complications induced by SARS-CoV-2 infection while providing an update on the vaccine development.
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Affiliation(s)
- Medha Karnik
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India
| | - Narasimha M Beeraka
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India
- Sechenov First Moscow State Medical University (Sechenov University), St. Trubetskaya, 8, bld. 2, Moscow, 119991, Russia
| | - Chinnappa A Uthaiah
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India
| | - Suma M Nataraj
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India
| | - Anjali Devi S Bettadapura
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India
| | - Gjumrakch Aliev
- Sechenov First Moscow State Medical University (Sechenov University), St. Trubetskaya, 8, bld. 2, Moscow, 119991, Russia
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Moscow Region, 142432, Russia
- Research Institute of Human Morphology, 3 Tsyurupy Street, Moscow, 117418, Russia
- GALLY International Research Institute, 7733 Louis Pasteur Drive, San Antonio, TX, #330, USA
| | - SubbaRao V Madhunapantula
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India.
- Special Interest Group in Cancer Biology and Cancer Stem Cells (SIG-CBCSC), JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India.
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Seferoğlu M, Ethemoğlu Ö, Turan ÖF, Siva A. MS and COVID-19 challenge: asymptomatic COVID-19 infection during treatment with cladribine. Neurol Sci 2021; 42:3533-3535. [PMID: 34165650 PMCID: PMC8223191 DOI: 10.1007/s10072-021-05409-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of disease-modifying therapies (DMTs) in people with multiple sclerosis (pwMS) may affect COVID-19 infection outcomes due to DMTs' immunomodulatory and immunosuppressive effects on immune response. The yet unknown issues are both the early response to the infection, as well as the post-infection development of immunity against the virus under these treatments due to their interaction with the immune system. METHODS We report two asymptomatic cases of COVID-19 in patients with relapsing-remitting multiple sclerosis (RRMS) shortly after starting cladribine therapy, both developed anti-SARS-CoV-2 antibody response. RESULTS Patients with MS who are under newly initiated treatment with cladribine tablets may experience an asymptomatic COVID-19 infection and they may develop immunity against SARS-CoV-2. CONCLUSION These observations raise the probability that DMTs with immunosuppressive effects, such as cladribine, may be considered as a treatment option for selected MS patients with high disease activity during the COVID-19 pandemic.
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Affiliation(s)
- Meral Seferoğlu
- Department of Neurology, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Özlem Ethemoğlu
- Department of Neurology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Ömer Faruk Turan
- Department of Neurology, Uludag University School of Medicine, Bursa, Turkey
| | - Aksel Siva
- Department of Neurology and MS Clinic, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Reyes S, Cunningham AL, Kalincik T, Havrdová EK, Isobe N, Pakpoor J, Airas L, Bunyan RF, van der Walt A, Oh J, Mathews J, Mateen FJ, Giovannoni G. Update on the management of multiple sclerosis during the COVID-19 pandemic and post pandemic: An international consensus statement. J Neuroimmunol 2021; 357:577627. [PMID: 34139567 PMCID: PMC8183006 DOI: 10.1016/j.jneuroim.2021.577627] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/13/2021] [Accepted: 06/05/2021] [Indexed: 12/16/2022]
Abstract
In this consensus statement, we provide updated recommendations on multiple sclerosis (MS) management during the COVID-19 crisis and the post-pandemic period applicable to neurology services around the world. Statements/recommendations were generated based on available literature and the experience of 13 MS expert panelists using a modified Delphi approach online. The statements/recommendations give advice regarding implementation of telemedicine; use of disease-modifying therapies and management of MS relapses; management of people with MS at highest risk from COVID-19; management of radiological monitoring; use of remote pharmacovigilance; impact on MS research; implications for lowest income settings, and other key issues.
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Affiliation(s)
- Saúl Reyes
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Fundación Santa Fe de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia; Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Eva Kubala Havrdová
- Department of Neurology and Center for Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Julia Pakpoor
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Laura Airas
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Reem F Bunyan
- Department of Neurology, Neurosciences Center, King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Joela Mathews
- Department of Pharmacy, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
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Özkeskin M, Özden F, Karaman B, Ekmekçi Ö, Yüceyar N. The comparison of fatigue, sleep quality, physical activity, quality of life, and psychological status in multiple sclerosis patients with or without COVID-19. Mult Scler Relat Disord 2021; 55:103180. [PMID: 34352513 PMCID: PMC8324500 DOI: 10.1016/j.msard.2021.103180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023]
Abstract
Purpose The study was purposed to investigate the effect of COVID-19 disease on fatigue, sleep quality, physical activity, quality of life, and psychological status in people with MS. Methods A total of 104 people with MS, including 46 of them with COVID-19 disease history, were enrolled in the study. All patients were evaluated with the Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire Short Form (IPAQ-SF), the EuroQoL Instrument (EQ-5D-3L), the Fear of COVID-19 Scale (FCV-19S) and the Coronavirus Anxiety Scale (CAS). Results People with MS in the COVID-19 positive group had a significantly lower IPAQ-Total score (p = 0.014). Besides, the FCV-19S scores of COVID-19 positive patients were significantly higher (p = 0.006). EQ-5D-3L Index and EQ-5D-3L VAS scores were higher in the group with COVID-19 (p1 = 0.021, p2 = 0.014, respectively). FCV-19S had a moderate correlation with EDSS (r = -0.362). IPAQ-Total was moderately associated with MS duration, EDSS and FSS (r1 = -0.471, r2 = -0.389, r3 = -0.388, respectively). The EQ-5D-3L Index was moderately correlated with FSS (r1 = -0.404). There was a weakly significant relationship between EQ-5D-3L Index and BMI, MS duration, PSQI and CAS (r1 = -0.471, r2 =-0.389, r3 = -0.388, r4 = -0.326, respectively). On the other hand, EQ-5D-3L was moderately associated with VAS and EDSS and PSQI (r1 = -0.393, r2 = -0.357, respectively). Conclusion COVID-19 negatively affected the people with MS's physical activity and coronavirus related fear parameters. However, the causality of this influence should be investigated in detail.
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Affiliation(s)
- Mehmet Özkeskin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ege University, İzmir, Turkey
| | - Fatih Özden
- Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Bedriye Karaman
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
| | - Özgül Ekmekçi
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
| | - Nur Yüceyar
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey.
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Bsteh G, Assar H, Hegen H, Heschl B, Leutmezer F, Di Pauli F, Gradl C, Traxler G, Zulehner G, Rommer P, Wipfler P, Guger M, Enzinger C, Berger T. COVID-19 severity and mortality in multiple sclerosis are not associated with immunotherapy: Insights from a nation-wide Austrian registry. PLoS One 2021; 16:e0255316. [PMID: 34314457 PMCID: PMC8315529 DOI: 10.1371/journal.pone.0255316] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic challenges neurologists in counselling patients with multiple sclerosis (pwMS) regarding their risk by SARS-CoV-2 and in guiding disease-modifying treatment (DMT). OBJECTIVE To characterize the prevalence and outcome of COVID-19 in pwMS specifically associated with different DMT in a nationwide population-based study. METHODS We included patients aged ≥18 years with a confirmed diagnosis of MS and a diagnosis of COVID-19 established between January 1, 2020 and December 31, 2020. We classified COVID-19 course as either mild, severe or fatal. Impact of DMT and specifically immunosuppressants (alemtuzumab, cladribine, fingolimod, ocrelizumab or rituximab) on COVID-19 outcome was determined by multivariable models, adjusted for a-priori-risk. RESULTS Of 126 MS patients with COVID-19 (mean age 43.2 years [SD 13.4], 71% female), 86.5% had a mild course, 9.5% a severe course and 3.2% died from COVID-19. A-priori-risk significantly predicted COVID-19 severity (R2 0.814; p<0.001) and mortality (R2 0.664; p<0.001). Adjusting for this a-priori-risk, neither exposure to any DMT nor exposure to specific immunosuppressive DMT were significantly associated with COVID-19 severity (odds ratio [OR] 1.6; p = 0.667 and OR 1.9; p = 0.426) or mortality (OR 0.5; p = 0.711 and 2.1; 0.233) when compared to no DMT. CONCLUSIONS In a population-based MS cohort, COVID-19 outcome was not associated with exposure to DMT and immunosuppressive DMT when accounting for other already known risk factors. This provides reassuring evidence that COVID-19 risk can be individually anticipated in MS and-except for a very small proportion of high-risk patients-treatment decisions should be primarily focused on treating MS rather than the pandemic.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Hamid Assar
- Department of Neurology, Kepler University Hospital, Linz, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Heschl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christiane Gradl
- Department of Neurology, Medical University of St. Pölten, St. Pölten, Austria
| | - Gerhard Traxler
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Wipfler
- Department of Neurology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Cabreira V, Abreu P, Soares-dos-Reis R, Guimarães J, Sá MJ. Multiple Sclerosis, Disease-Modifying Therapies and COVID-19: A Systematic Review on Immune Response and Vaccination Recommendations. Vaccines (Basel) 2021; 9:773. [PMID: 34358189 PMCID: PMC8310076 DOI: 10.3390/vaccines9070773] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/11/2022] Open
Abstract
Understanding the risks of COVID-19 in patients with Multiple Sclerosis (MS) receiving disease-modifying therapies (DMTs) and their immune reactions is vital to analyze vaccine response dynamics. A systematic review on COVID-19 course and outcomes in patients receiving different DMTs was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Emerging data on SARS-CoV-2 vaccines was used to elaborate recommendations. Data from 4417 patients suggest that MS per se do not portend a higher risk of severe COVID-19. As for the general population, advanced age, comorbidities, and higher disability significantly impact COVID-19 outcomes. Most DMTs have a negligible influence on COVID-19 incidence and outcome, while for those causing severe lymphopenia and hypogammaglobulinemia, such as anti-CD20 therapies, there might be a tendency of increased hospitalization, worse outcomes and a higher risk of re-infection. Blunted immune responses have been reported for many DMTs, with vaccination implications. Clinical evidence does not support an increased risk of MS relapse or vaccination failure, but vaccination timing needs to be individually tailored. For cladribine and alemtuzumab, it is recommended to wait 3-6 months after the last cycle until vaccination. For the general anti-CD20 therapies, vaccination must be deferred toward the end of the cycle and the next dose administered at least 4-6 weeks after completing vaccination. Serological status after vaccination is highly encouraged. Growing clinical evidence and continuous surveillance are extremely important to continue guiding future treatment strategies and vaccination protocols.
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Affiliation(s)
- Verónica Cabreira
- Serviço de Neurologia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (P.A.); (R.S.-d.-R.); (J.G.); (M.J.S.)
- Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Pedro Abreu
- Serviço de Neurologia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (P.A.); (R.S.-d.-R.); (J.G.); (M.J.S.)
- Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Ricardo Soares-dos-Reis
- Serviço de Neurologia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (P.A.); (R.S.-d.-R.); (J.G.); (M.J.S.)
- Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
- i3S-Instituto de Investigação e Inovação da Universidade do Porto, 4200-135 Porto, Portugal
| | - Joana Guimarães
- Serviço de Neurologia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (P.A.); (R.S.-d.-R.); (J.G.); (M.J.S.)
- Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Maria José Sá
- Serviço de Neurologia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (P.A.); (R.S.-d.-R.); (J.G.); (M.J.S.)
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
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Romero JP, Bravo-Martín A, Oliva-Navarrete P, Sánchez-Cuesta F, Ríos-Lago M, Benito-León J. Impact of COVID-19 on a brain damage unit. Diabetes Metab Syndr 2021; 15:102163. [PMID: 34186362 PMCID: PMC8180341 DOI: 10.1016/j.dsx.2021.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 12/15/2022]
Abstract
AIM To report on the impact of COVID-19 on a brain damage unit. METHODS We reviewed the records of all patients admitted to our brain damage unit. The study included all the significant clinical events from the first positive qualitative real-time reverse-transcriptase-polymerase-chain-reaction assay (April 8th, 2020) for SARS-CoV-2 to the day all patients tested negative (June 8th, 2020). RESULTS Of the 20 patients (14 men) (age 57.7 ± 14.9; 2-71 months after brain damage; all with a modified Rankin scale score > 4), 16 tested positive for SARS-CoV-2 and remained positive for a mean of 32.3 days (ranging from 26 to 61). One patient died from COVID-19, while 12 patients were asymptomatic and three suffered mild pneumonia without acute respiratory distress syndrome. All patients received prophylactic subcutaneous heparin. Intravenous methylprednisolone was prescribed for three patients with bilateral pneumonia with excellent results. CONCLUSIONS Most positive cases (93.7%) were not severe. The good outcome was most likely due to the use of prophylactic anticoagulation therapy, the early use of methylprednisolone for pneumonia and the previously reported immunosuppression amid patients with brain damage. This study hopes to encourage further study into brain damage immunity.
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Affiliation(s)
- Juan Pablo Romero
- Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain; Experimental Sciences Faculty, Francisco de Vitoria University, Madrid, Spain.
| | | | | | | | - Marcos Ríos-Lago
- Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain; Department of Basic Psychology, UNED, Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain.
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Moreno-Torres I, Meca Lallana V, Costa-Frossard L, Oreja-Guevara C, Aguirre C, Alba Suárez EM, Gómez Moreno M, Borrega Canelo L, Sabín Muñoz J, Aladro Y, Cárcamo A, Rodríguez García E, Cuello JP, Monreal E, Sainz de la Maza S, Pérez Parra F, Valenzuela Rojas F, López de Silanes de Miguel C, Casanova I, Martínez Gines ML, Blasco R, Orviz García A, Villar-Guimerans LM, Fernández-Dono G, Elvira V, Santiuste C, Espiño M, García Domínguez JM. Risk and outcomes of COVID-19 in patients with multiple sclerosis. Eur J Neurol 2021; 28:3712-3721. [PMID: 34152073 PMCID: PMC8444942 DOI: 10.1111/ene.14990] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/30/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Background and purpose Limited information is available on incidence and outcomes of COVID‐19 in patients with multiple sclerosis (MS). This study investigated the risks of SARS‐CoV‐2 infection and COVID‐19‐related outcomes in patients with MS, and compared these with the general population. Methods A regional registry was created to collect data on incidence, hospitalization rates, intensive care unit admission, and death in patients with MS and COVID‐19. National government outcomes and seroprevalence data were used for comparison. The study was conducted at 14 specialist MS treatment centers in Madrid, Spain, between February and May 2020. Results Two‐hundred nineteen patients were included in the registry, 51 of whom were hospitalized with COVID‐19. The mean age ± standard deviation was 45.3 ± 12.4 years, and the mean duration of MS was 11.9 ± 8.9 years. The infection incidence rate was lower in patients with MS than the general population (adjusted incidence rate ratio = 0.78, 95% confidence interval [CI] = 0.70–0.80), but hospitalization rates were higher (relative risk = 5.03, 95% CI = 3.76–6.62). Disease severity was generally low, with only one admission to an intensive care unit and five deaths. Males with MS had higher incidence rates and risk of hospitalization than females. No association was found between the use of any disease‐modifying treatment and hospitalization risk. Conclusions Patients with MS do not appear to have greater risks of SARS‐CoV‐2 infection or severe COVID‐19 outcomes compared with the general population. The decision to start or continue disease‐modifying treatment should be based on a careful risk–benefit assessment.
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Affiliation(s)
- Irene Moreno-Torres
- Demyelinating Diseases Unit, Jiménez Diaz Foundation University Hospital, Madrid, Spain
| | | | | | - Celia Oreja-Guevara
- Department of Neurology, Department of Medicine, Faculty of Medicine, San Carlos Clinical Hospital, Complutense University of Madrid and San Carlos Institute for Health Research, Madrid, Spain
| | - Clara Aguirre
- Demyelinating Diseases Unit, La Princesa University Hospital, Madrid, Spain
| | | | | | | | - Julia Sabín Muñoz
- Neuroimmunology Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Yolanda Aladro
- Demyelinating Diseases Unit, University Hospital of Getafe, Madrid, Spain
| | - Alba Cárcamo
- Demyelinating Diseases Unit, University Hospital of Getafe, Madrid, Spain
| | | | - Juan Pablo Cuello
- Demyelinating Diseases Unit, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Enric Monreal
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - Rosario Blasco
- Neuroimmunology Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Aida Orviz García
- Demyelinating Diseases Unit, Jiménez Diaz Foundation University Hospital, Madrid, Spain
| | | | | | | | - Carmen Santiuste
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Mercedes Espiño
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
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Kalra RS, Dhanjal JK, Meena AS, Kalel VC, Dahiya S, Singh B, Dewanjee S, Kandimalla R. COVID-19, Neuropathology, and Aging: SARS-CoV-2 Neurological Infection, Mechanism, and Associated Complications. Front Aging Neurosci 2021; 13:662786. [PMID: 34149397 PMCID: PMC8209245 DOI: 10.3389/fnagi.2021.662786] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
The spectrum of health complications instigated by coronavirus disease 2019 (COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) pandemic has been diverse and complex. Besides the evident pulmonary and cardiovascular threats, accumulating clinical data points to several neurological complications, which are more common in elderly COVID-19 patients. Recent pieces of evidence have marked events of neuro infection and neuroinvasion, producing several neurological complications in COVID-19 patients; however, a systematic understanding of neuro-pathophysiology and manifested neurological complications, more specifically in elderly COVID-19 patients is largely elusive. Since the elderly population gradually develops neurological disorders with aging, COVID-19 inevitably poses a higher risk of neurological manifestations to the aged patients. In this report, we reviewed SARS-CoV-2 infection and its role in neurological manifestations with an emphasis on the elderly population. We reviewed neuropathological events including neuroinfection, neuroinvasion, and their underlying mechanisms affecting neuromuscular, central- and peripheral- nervous systems. We further assessed the imminent neurological challenges in the COVID-19 exposed population, post-SARS-CoV-2-infection. Given the present state of clinical preparedness, the emerging role of AI and machine learning was also discussed concerning COVID-19 diagnostics and its management. Taken together, the present review summarizes neurological outcomes of SARS-CoV-2 infection and associated complications, specifically in elderly patients, and underlines the need for their clinical management in advance.
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Affiliation(s)
- Rajkumar Singh Kalra
- AIST-INDIA DAILAB, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Jaspreet Kaur Dhanjal
- Department of Computational Biology, Indraprastha Institute of Information Technology Delhi, Okhla Industrial Estate, New Delhi, India
| | - Avtar Singh Meena
- CSIR-Centre for Cellular and Molecular Biology (CCMB), Hyderabad, India
| | - Vishal C. Kalel
- Department of Systems Biochemistry, Institute of Biochemistry and Pathobiochemistry, Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Surya Dahiya
- Conservative Dentistry and Endodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Ambala, India
| | - Birbal Singh
- ICAR-Indian Veterinary Research Institute (IVRI), Regional Station, Palampur, India
| | - Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Chemical Technology (IICT), Hyderabad, India
- Department of Biochemistry, Kakatiya Medical College, Warangal, India
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Kulikowska J, Kulczyńska-Przybik A, Mroczko B, Kułakowska A. The Significance of COVID-19 Immunological Status in Severe Neurological Complications and Multiple Sclerosis-A Literature Review. Int J Mol Sci 2021; 22:5894. [PMID: 34072715 PMCID: PMC8199258 DOI: 10.3390/ijms22115894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2/Coronavirus 2019 (COVID-19) is responsible for the pandemic, which started in December 2019. In addition to the typical respiratory symptoms, this virus also causes other severe complications, including neurological ones. In diagnostics, serological and polymerase chain reaction tests are useful not only in detecting past infections but can also predict the response to vaccination. It is now believed that an immune mechanism rather than direct viral neuroinvasion is responsible for neurological symptoms. For this reason, it is important to assess the presence of antibodies not only in the serum but also in the cerebrospinal fluid (CSF), especially in the case of neuro-COVID. A particular group of patients are people with multiple sclerosis (MS) whose disease-modifying drugs weaken the immune system and lead to an unpredictable serological response to SARS-CoV-2 infection. Based on available data, the article summarizes the current serological information concerning COVID-19 in CSF in patients with severe neurological complications and in those with MS.
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Affiliation(s)
- Joanna Kulikowska
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Agnieszka Kulczyńska-Przybik
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (B.M.)
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland; (A.K.-P.); (B.M.)
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, 15-276 Bialystok, Poland;
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Barzegar M, Mirmosayyeb O, Gajarzadeh M, Afshari-Safavi A, Nehzat N, Vaheb S, Shaygannejad V, Maghzi AH. COVID-19 Among Patients With Multiple Sclerosis: A Systematic Review. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/4/e1001. [PMID: 34016734 PMCID: PMC8142838 DOI: 10.1212/nxi.0000000000001001] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/05/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We systematically reviewed the literature on COVID-19 in patients with multiple sclerosis (MS). METHODS We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Google Scholar, and World Health Organization database from December 1, 2019, to December 18, 2020. Three conference abstract databases were also searched. We included any types of studies that reported characteristics of patients with MS with COVID-19. RESULTS From an initial 2,679 publications and 3,138 conference abstracts, 87 studies (67 published articles and 20 abstracts) consisting of 4,310 patients with suspected/confirmed COVID-19 with MS met the inclusion criteria. The female/male ratio was 2.53:1, the mean (SD) age was 44.91 (4.31) years, the mean disease duration was 12.46 (2.27), the mean Expanded Disability Status Scale score was 2.54 (0.81), the relapsing/progressive ratio was 4.75:1, and 32.9% of patients had at least 1 comorbidity. The most common symptoms were fever (68.8%), followed by cough (63.9%), fatigue/asthenia (51.2%), and shortness of breath (39.5%). In total, 837 of 4,043 patients with MS with suspected/confirmed COVID-19 (20.7%) required hospitalization, and 130 of 4,310 (3.0%) died of COVID-19. Among suspected/confirmed patients, the highest hospitalization and mortality rates were in patients with no disease-modifying therapies (42.9% and 8.4%), followed by B cell-depleting agents (29.2% and 2.5%). CONCLUSION Our study suggested that MS did not significantly increase the mortality rate from COVID-19. These data should be interpreted with caution as patients with MS are more likely female and younger compared with the general population where age and male sex seem to be risk factors for worse disease outcome.
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Affiliation(s)
- Mahdi Barzegar
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Omid Mirmosayyeb
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mahsa Gajarzadeh
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alireza Afshari-Safavi
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nasim Nehzat
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Saeed Vaheb
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vahid Shaygannejad
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Amir-Hadi Maghzi
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Diaz de la Fe A, Peláez Suárez AA, Fuentes Campos M, Cabrera Hernández MN, Goncalves CA, Schultz S, Siniscalco D, Robinson-Agramonte MA. SARS-CoV-2 Infection and Risk Management in Multiple Sclerosis. Diseases 2021; 9:diseases9020032. [PMID: 33921878 PMCID: PMC8167598 DOI: 10.3390/diseases9020032] [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: 03/01/2021] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 12/24/2022] Open
Abstract
The novel coronavirus can cause a severe respiratory disease with impact on the central nervous system, as has been reported by several medical health services. In the COVID-19 pandemic caused by the SARS-CoV-2 neurotrophic virus, neurologists have focused their attention on the early identification of suggestive manifestations of the neurological impact of the disease. In this context, they are exploring related chronic disease and the possibility of achieving a more effective understanding of symptoms derived from COVID-19 infection and those derived from the course of preexisting neurological disease. The present review summarizes evidence from the infection with SARS-CoV-2 and the management of the risks of multiple sclerosis and how it is related to the risks of general comorbidities associated with COVID-19. In addition, we reviewed other factors characteristic of MS, such as relapses, and the maximum tolerated dose of treatment medications from clinical and experimental evidence.
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Affiliation(s)
- Amado Diaz de la Fe
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana 11300, Cuba; (A.D.d.l.F.); (A.A.P.S.)
| | - Alejandro Armando Peláez Suárez
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana 11300, Cuba; (A.D.d.l.F.); (A.A.P.S.)
| | - Marinet Fuentes Campos
- Departamento de Medicina Familiar y Comunitaria Policlínico 28 de Enero, Habana 11300, Cuba;
| | | | - Carlos-Alberto Goncalves
- Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre 90040-060, Brazil;
| | - Stephen Schultz
- Department of Cellular and Integrative Physiology, Center for Biomedical Neuroscience, University of Texas (UT) Health Science Center San Antonio, San Antonio, TX 78229, USA;
| | - Dario Siniscalco
- Department of Experimental Medicine, University of Campania, 80138 Naples, Italy;
| | - Maria Angeles Robinson-Agramonte
- Neuroimmunology Department, Research Center, International Center for Neurological Restoration, Habana 11300, Cuba
- Correspondence:
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Morrison EH, Michtich K, Hersh CM. How the COVID-19 Pandemic has changed multiple sclerosis clinical practice: Results of a nationwide provider survey. Mult Scler Relat Disord 2021; 51:102913. [PMID: 33839482 PMCID: PMC7969827 DOI: 10.1016/j.msard.2021.102913] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/02/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
Background The COVID-19 crisis has created unanticipated changes in health care delivery for people living with multiple sclerosis (MS). The pandemic's rapid evolution has resulted in a knowledge gap in how COVID-19 has affected MS clinical practice. Our objective was to understand how the COVID-19 pandemic has affected clinical practice patterns in a nationwide cohort of MS clinicians across the United States. Methods In collaboration with the National Multiple Sclerosis Society (NMSS), we developed a 28-item SurveyMonkeyTM electronic questionnaire exploring MS specialists’ perceptions of how COVID-19 has altered how they prescribe MS disease-modifying therapies (DMTs), provide telehealth and other services, and view issues affecting their own well-being including re-deployment to the front lines of COVID-19 care and availability of personal protective equipment (PPE). NMSS staff sent a recruitment email containing the electronic survey link to 188 clinicians who serve on regional NMSS Healthcare Provider Councils across the US, 86 (45.7%) of whom were MS specialist physicians. Results Eighty-six of 188 potential respondents (45.7%) from 32 US states completed the survey including 45 physicians (41 neurologists, 3 physiatrists and 1 family physician), 18 rehabilitation therapists, 7 psychologists, 6 nurse practitioners, 4 social workers, 2 physician assistants, 2 nurses and 2 health professionals from other disciplines. More than 80% of all respondents working on-site in a health care setting believed they had adequate PPE. More than 41% were able to distance safely from others at work. Nearly 10% of respondents reported they had been re-deployed to the front lines of COVID-19 patient care, and an additional 16.9% anticipated being re-deployed. Among the MS specialist physician subgroup, nearly one-third reported using telemedicine to provide over 75% of their clinical care. Only 16.7% believed COVID-19 had not changed how they prescribe DMTs. Therapies prescribed more often during the pandemic included β-IFNs (28.6% of prescribers), natalizumab (23.8%), glatiramer acetate (21.4%) and teriflunomide (19%). DMTs prescribed less often included alemtuzumab (64.3% of prescribers), cladribine (54.8%), ocrelizumab and rituximab (50%), and fingolimod and siponimod (40.5%). For at least some of their patients during the pandemic, some MS specialists reported suspending certain DMTs including alemtuzumab (21.4% of prescribers), ocrelizumab and rituximab (16.7%) and cladribine (11.9%). Others reported extending DMT dosing intervals for natalizumab (38.1%), fingolimod and siponimod (11.9%). Conclusions In this nationwide survey, MS specialist physicians and other clinicians serving on regional NMSS Healthcare Provider Councils across the US reported profound changes in how they are delivering MS care during the COVID-19 pandemic.
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Affiliation(s)
- Elizabeth H Morrison
- University of California, Riverside School of Medicine, Riverside, California, 900 University Avenue, Riverside, California 92521, United States.
| | - Katelyn Michtich
- National Multiple Sclerosis Society, Southern California and Nevada Chapter, 5150 Goldleaf Circle, Los Angeles, California 90056, United States
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 W. Bonneville Avenue, Las Vegas, Nevada 89106, United States.
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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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Al-Rabia MW, Alhakamy NA, Ahmed OAA, Eljaaly K, Alaofi AL, Mostafa A, Asfour HZ, Aldarmahi AA, Darwish KM, Ibrahim TS, Fahmy UA. Repurposing of Sitagliptin- Melittin Optimized Nanoformula against SARS-CoV-2: Antiviral Screening and Molecular Docking Studies. Pharmaceutics 2021; 13:307. [PMID: 33652894 PMCID: PMC8025909 DOI: 10.3390/pharmaceutics13030307] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
The outbreak of the COVID-19 pandemic in China has become an urgent health and economic challenge. The objective of the current work was to evaluate the efficacy of the combined complex of Sitagliptin (SIT) with melittin (MEL) against SARS-CoV-2 virus. SIT-MEL nano-conjugates were optimized by a full three-factor bi-level (23) factorial design. In addition, SIT concentration (mM, X1), MEL concentration (mM, X2), and pH (X3) were selected as the critical factors. Particle size (nm, Y1) and zeta potential (mV, Y2) were assessed as responses. Characterization of the optimized formula for Fourier-transformed infrared (FTIR) was carried out. The optimized formula showed particle size and zeta potential values of 77.42 nm and 27.67 mV, respectively. When compared with SIT and MEL, the combination of SIT-MEL complex has shown anti-viral potential against isolate of SARS-CoV-2 with IC50 values of 8.439 μM with significant improvement (p < 0.001). In addition, the complex showed IC50 in vitro 3CL-protease inhibition with IC50 7.216 µM. Molecular docking has revealed that formula components have good predicted pocket accommodation of the SARS-CoV-2 3-CL protease. An optimized formulation of SIT-MEL could guarantee both enhanced delivery to the target cells and the enhanced cellular uptake with promising activities against SARS-CoV-2.
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Affiliation(s)
- Mohammed W. Al-Rabia
- Department of Medical microbiology and parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (M.W.A.-R.); (H.Z.A.)
| | - Nabil A. Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (O.A.A.A.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Mohamed Saeed Tamer Chair for Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Osama A. A. Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (O.A.A.A.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Mohamed Saeed Tamer Chair for Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Khalid Eljaaly
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Pharmacy Practice and Science Department, College of Pharmacy, University of Arizona, Tucson, AZ 85704, USA
| | - Ahmed L. Alaofi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Ahmed Mostafa
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt;
| | - Hani Z. Asfour
- Department of Medical microbiology and parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (M.W.A.-R.); (H.Z.A.)
| | - Ahmed A. Aldarmahi
- College of Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21582, Saudi Arabia;
| | - Khaled M. Darwish
- Medicinal Chemistry Department, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt;
| | - Tarek S. Ibrahim
- Department of Pharmaceutical chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Usama A. Fahmy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (O.A.A.A.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Mohamed Saeed Tamer Chair for Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Alhakamy NA, Ahmed OAA, Ibrahim TS, Aldawsari HM, Eljaaly K, Fahmy UA, Alaofi AL, Caraci F, Caruso G. Evaluation of the Antiviral Activity of Sitagliptin-Glatiramer Acetate Nano-Conjugates against SARS-CoV-2 Virus. Pharmaceuticals (Basel) 2021; 14:178. [PMID: 33668390 PMCID: PMC7996174 DOI: 10.3390/ph14030178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/11/2022] Open
Abstract
The outbreak of the COVID-19 pandemic in China has become an urgent health and economic challenge. There is a current race for developing strategies to treat and/or prevent COVID-19 worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of coronavirus that causes COVID-19. The aim of the present work was to evaluate the efficacy of the combined complex (nano-conjugates) of two FDA-approved drugs, sitagliptin (SIT) and glatiramer acetate (GA), against a human isolate of the SARS-CoV-2 virus. SIT-GA nano-conjugates were prepared according to a full three-factor bilevel (23) factorial design. The SIT concentration (mM, X1), GA concentration (mM, X2), and pH (X3) were selected as the factors. The particle size (nm, Y1) and zeta potential (mV, Y2) were assessed as responses. Characterization of the optimized formula for the Fourier-transform infrared (FTIR) spectroscopy and transmission electron microscopy (TEM) was carried out. In addition, the half-maximal inhibitory concentration (IC50) in Vero-E6 epithelial cells previously infected with the virus was investigated. The results revealed that the optimized formula of the prepared complex was a 1:1 SIT:GA molar ratio at a pH of 10, which met the required criteria with a desirability value of 0.878 and had a particle size and zeta potential at values of 77.42 nm and 27.67 V, respectively. The SIT-GA nano-complex showed antiviral potential against an isolate of SARS-CoV-2 with IC50 values of 16.14, 14.09, and 8.52 µM for SIT, GA, and SIT-GA nano-conjugates, respectively. Molecular docking has shown that the formula's components have a high binding affinity to the COVID 3CL protease, essential for coronavirus replication, paralleled by 3CL protease inhibition (IC50 = 2.87 µM). An optimized formulation of SIT-GA could guarantee both enhanced deliveries to target cells and improved cellular uptake. Further clinical studies are being carried out to validate the clinical efficacy of the optimized formulation against SARS-CoV-2.
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Affiliation(s)
- Nabil A. Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (O.A.A.A.); (H.M.A.); (U.A.F.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Mohamed Saeed Tamer Chair for Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Osama A. A. Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (O.A.A.A.); (H.M.A.); (U.A.F.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Mohamed Saeed Tamer Chair for Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Tarek S. Ibrahim
- Department of Organic chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Hibah M. Aldawsari
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (O.A.A.A.); (H.M.A.); (U.A.F.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Mohamed Saeed Tamer Chair for Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Khalid Eljaaly
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Pharmacy Practice and Science Department, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | - Usama A. Fahmy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (O.A.A.A.); (H.M.A.); (U.A.F.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmed L. Alaofi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, 95125 Catania, Italy
- Oasi Research Institute—IRCCS, 94018 Troina, Italy
| | - Giuseppe Caruso
- Department of Drug and Health Sciences, University of Catania, 95125 Catania, Italy
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Zhang Y, Staker E, Cutter G, Krieger S, Miller AE. Perceptions of risk and adherence to care in MS patients during the COVID-19 pandemic: A cross-sectional study. Mult Scler Relat Disord 2021; 50:102856. [PMID: 33662858 PMCID: PMC7899915 DOI: 10.1016/j.msard.2021.102856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/02/2020] [Accepted: 02/20/2021] [Indexed: 11/25/2022]
Abstract
Background The COVID-19 pandemic has raised concerns for increased risk of infection in patients with multiple sclerosis (MS) and disrupted their routine MS care. The aim of this study is to characterize the extent of MS patients’ perceptions of risk and adherence to care during the pandemic. Methods A survey was emailed to patients from a large MS center in New York City during the local peak of the pandemic to assess perceptions of infection risk and adherence to MS care including appointments, laboratory studies, MRIs, and taking disease-modifying therapies (DMT). Results 529 patients from the MS center responded to the survey during two weeks in April 2020. Patients collectively showed concern about becoming infected with COVID-19 (88%) and perceived a higher infection risk due of having MS (70%) and taking DMTs (68%). Patients frequently postponed appointments (41%), laboratory studies (46%), and MRIs (41%). Noncompliance with DMTs was less common (13%). Decisions to alter usual recommendations for care were made by the patient more often than by the provider regarding adherence to appointments (68%), laboratory studies (70%), MRI (67%), and DMT (65%). Degree of concern for infection was associated with adherence to appointments (p=0.020) and laboratory studies (p=0.016) but not with adherence to MRI and DMTs. Thirty-five patients reported being tested for COVID-19, of whom fourteen reported a positive test. Conclusion Patients with MS were highly concerned about becoming infected during the local peak of the COVID-19 pandemic. Behaviors that deviated from originally recommended MS care were common and often self-initiated, but patients were overall compliant with continuing DMTs.
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Affiliation(s)
- Yinan Zhang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Erin Staker
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Aaron E Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review. Mult Scler Relat Disord 2021; 50:102800. [PMID: 33578206 PMCID: PMC7845520 DOI: 10.1016/j.msard.2021.102800] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022]
Abstract
Introduction The Coronavirus disease-19 (COVID-19) pandemic continues to expand across the world. This pandemic has had a significant impact on patients with chronic diseases. Among patients with demyelinating diseases of the central nervous system (CNS), such as Multiple Sclerosis (MS) or Neuromyelitis Optica Spectrum Disorder (NMOSD), concerns remain about the potential impact of COVID-19 on these patients given their treatment with immunosuppressive or immunomodulatory therapies. In this study, we review the existing literature investigating the impact of disease-modifying therapies(DMT) on COVID-19 risks in this group of patients. Method For this systematic review, we searched PubMed from January 1, 2020, to December 3, 2020. The following keywords were used: “COVID-19” AND “Multiple Sclerosis” OR “Neuromyelitis Optica.” Articles evaluating COVID-19 in patients with demyelinating diseases of CNS were included. This study evaluates the different aspects of the DMTs in these patients during the COVID-19 era. Results and conclusion A total of 262 articles were found. After eliminating duplicates and unrelated research papers, a total of 84 articles met the final inclusion criteria in our study. Overall, the experiences of 2493 MS patients and 37 NMOSD patients with COVID-19 were included in this review. Among them, 46(1.8%) MS patients died(the global death-to-case ratio of Covid-19 was reported about 2.1%). Among DMTs, Rituximab had the highest mortality rate (4%). Despite controversies, especially concerning anti-CD20 monoclonal antibody therapies, a relation between DMT-use and COVID-19 disease- course was not found in many studies. This observation reinforces the recommendation of not stopping current DMTs. Other variables such as age, higher expanded disability status scale (EDSS) scores, cardiac comorbidities, and obesity were independent risk factors for severe COVID-19. Despite the risks of infection, most patients were willing to continue their DMT during the pandemic because of more significant concern about the risk of relapse or worsening MS symptoms. After the infection, an immune response's attenuation was seen in the patients on Fingolimod and anti-CD20 monoclonal antibodies. This may be a critical finding in future vaccinations.
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