1
|
Burian K, Heidler F, Frahm N, Hecker M, Langhorst SE, Mashhadiakbar P, Streckenbach B, Baldt J, Meißner J, Richter J, Zettl UK. Vaccination status and self-reported side effects after SARS-CoV-2 vaccination in relation to psychological and clinical variables in patients with multiple sclerosis. Sci Rep 2024; 14:12248. [PMID: 38806524 PMCID: PMC11133397 DOI: 10.1038/s41598-024-62541-x] [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: 11/14/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
The recent SARS-CoV-2 pandemic and the vaccination campaign posed a challenge to patients with autoimmune disease, such as multiple sclerosis (MS). We aimed for investigating whether psychological/sociodemographic/clinical characteristics of MS patients are associated with SARS-CoV-2 vaccination status and self-reported vaccination side effects (SEs). We have asked patients with MS about their willingness to receive recommended standard vaccinations pre-pandemically since June 2019. Between 10/2021 and 01/2022, we surveyed 193 of these MS patients about their current SARS-CoV-2 vaccination status, their perception of vaccination-related SEs, and reasons for and against SARS-CoV-2 vaccination. 75.6% of the patients declared their willingness to receive standard vaccinations before the pandemic. 84.5%, 78.2%, and 13.0% of the patients had received the first, second, and third SARS-CoV-2 vaccination, respectively, until the follow-up survey. The most common reason for not getting vaccinated against SARS-CoV-2 was concern about possible side effects (82.1%), followed by the belief that the vaccines had not been adequately tested (64.3%). Vaccination-related SEs were reported by 52.8% of the patients. Younger age, higher education, lower degree of disability, relapsing disease course, shorter disease duration, not receiving a disease-modifying therapy and higher anxiety and depression levels were associated with the occurrence of certain vaccination-related SEs. Concerns about novel vaccines are widespread among MS patients and necessitate targeted education of the patients, especially to those with more severe psychopathological symptoms (anxiety or depression) and those who are generally skeptical of vaccination.
Collapse
Affiliation(s)
- Katja Burian
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany.
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany.
| | - Felicita Heidler
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Janina Meißner
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
| | - Jörg Richter
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Pfafferode 102, 99974, Mühlhausen, Germany
- Faculty of Health Sciences, University of Hull, Cottingham Rd, Hull, HU6 7RX, UK
- Durham Law School, The Palatine Centre, Durham University, Stockton Rd, Durham, DH1 3LE, UK
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147, Rostock, Germany
| |
Collapse
|
2
|
Mathew T, Garg S, John SK, Kimi MS, Chhakchhuak NZ, Koshy S, Yangdonq T, George M, Bhardwaj S, Reddy YM, Murgod U, Kamath V, Shivde S, Badachi S, Huddar A, Sarma GRK, Nadig R. COVID-19 Infection in Multiple Sclerosis Patients Treated with Rituximab Compared to Natalizumab and Healthy Controls: A Real-World Multicenter Study. Ann Indian Acad Neurol 2024; 27:264-268. [PMID: 38902864 PMCID: PMC11232821 DOI: 10.4103/aian.aian_151_24] [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: 03/02/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION The impact of coronavirus disease 2019 (COVID-19) infection on patients with multiple sclerosis (MS) undergoing various immunomodulating therapies can vary. Individuals on B-cell therapy, such as rituximab, may be more susceptible to infection compared to those treated with natalizumab. OBJECTIVE The objective of this study was to determine the incidence and severity of COVID-19 infection in patients receiving rituximab, natalizumab, and healthy controls. METHODS This retrospective multicentric study included data derived from a centralized MS registry of four centers in South India. Data of patients on rituximab and natalizumab recruited between 2020 February and 2022 December were extracted from the registry and analyzed. The outcomes studied were the occurrence of COVID-19 infection, hospitalization, intensive care unit admission, death, post-COVID-19 relapses, and post-vaccine relapses. These outcomes were compared between the treatment groups and the matched controls. RESULTS COVID-19 infection occurred in 49.1% (26/53) of those on rituximab, 19.2% (5/26) of those on natalizumab, and 11.5% (6/52) of healthy controls. In addition, 8/53 (15.1%) in the rituximab group and 1/26 (3.8%) in the natalizumab group were hospitalized. All 6/52 (11.5%) in the control group had mild infection, and none were hospitalized. No deaths occurred in any group. On statistical analysis, the occurrence of COVID-19 infection in the rituximab group was significantly higher when compared to natalizumab ( P = 0.0141) and healthy controls ( P < 0.001). Hospitalizations were significantly higher in the rituximab group when compared to healthy controls ( P < 0.006). CONCLUSION MS patients treated with rituximab were more likely to experience COVID-19 infection compared to those treated with natalizumab and healthy controls. Hospitalization was more frequently seen in patients treated with rituximab compared to healthy controls.
Collapse
Affiliation(s)
- Thomas Mathew
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Surabhi Garg
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Saji K. John
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Mal S. Kimi
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Naom Z. Chhakchhuak
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Sherina Koshy
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Tenzin Yangdonq
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Molly George
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Shagun Bhardwaj
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Yerasu M. Reddy
- Department of Neurology, Care Hospital, Hyderabad, Telangana, India
| | - Uday Murgod
- Department of Neurology, Manipal Hospitals, HAL Old Airport Rd, Bengaluru, Karnataka, India
| | - Vikram Kamath
- Department of Neurology, Trustwell Hospital Pvt. Ltd., Bengaluru, Karnataka, India
| | - Sonia Shivde
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Sagar Badachi
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Akshata Huddar
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Gosala R. K. Sarma
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Raghunandan Nadig
- Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
3
|
Woo HG, Kim HJ, Park J, Lee J, Lee H, Kim MS, Koyanagi A, Smith L, Rahmati M, Yeo SG, Yon DK. Global burden of vaccine-associated multiple sclerosis, 1967-2022: A comprehensive analysis of the international pharmacovigilance database. J Med Virol 2024; 96:e29591. [PMID: 38572940 DOI: 10.1002/jmv.29591] [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: 01/07/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Vaccine-associated multiple sclerosis (MS) is rare, with insufficient evidence from case reports. Given the scarcity of large-scale data investigating the association between vaccine administration and adverse events, we investigated the global burden of vaccine-associated MS and potential related vaccines from 1967 to 2022. Reports on vaccine-associated MS between 1967 and 2022 were obtained from the World Health Organization International Pharmacovigilance Database (total number of reports = 120 715 116). We evaluated global reports, reporting odds ratio (ROR), and information components (IC) to investigate associations between 19 vaccines and vaccine-associated MS across 156 countries and territories. We identified 8288 reports of vaccine-associated MS among 132 980 cases of all-cause MS. The cumulative number of reports on vaccine-associated MS gradually increased over time, with a substantial increase after 2020, owing to COVID-19 mRNA vaccine-associated MS. Vaccine-associated MS develops more frequently in males and adolescents. Nine vaccines were significantly associated with higher MS reporting, and the highest disproportional associations were observed for hepatitis B vaccines (ROR 19.82; IC025 4.18), followed by encephalitis (ROR 7.42; IC025 2.59), hepatitis A (ROR 4.46; IC025 1.95), and papillomavirus vaccines (ROR 4.45; IC025 2.01). Additionally, MS showed a significantly disproportionate signal for COVID-19 mRNA vaccines (ROR 1.55; IC025 0.52). Fatal clinical outcomes were reported in only 0.3% (21/8288) of all cases of vaccine-associated MS. Although various vaccines are potentially associated with increased risk of MS, we should be cautious about the increased risk of MS following vaccination, particularly hepatitis B and COVID-19 mRNA vaccines, and should consider the risk factors associated with vaccine-associated MS.
Collapse
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Min Seo Kim
- Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille (APHM), Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Seung Geun Yeo
- Department of Otolaryngology-Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| |
Collapse
|
4
|
Di Filippo M, Ferraro D, Ragonese P, Prosperini L, Maniscalco GT, Gallo A, Cavalla P, Lorefice L, Nociti V, Di Sabatino E, Clerico M, Guaschino C, Radaelli M, Fantozzi R, Buttari F, Laroni A, Gajofatto A, Calabrese M, Malucchi S, Paolicelli D, De Luca G, Tomassini V, Lanzillo R, Moccia M, Solaro C, Cocco E, Gasperini C, Tortorella C. SARS-CoV-2 vaccination and multiple sclerosis: a large multicentric study on relapse risk after the third booster dose. J Neurol 2024; 271:24-31. [PMID: 37922069 PMCID: PMC10769943 DOI: 10.1007/s00415-023-12034-0] [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: 07/07/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND COVID-19 vaccines have been recommended to people with multiple sclerosis (pwMS) and, to ensure durable immunity, a third booster dose has been administered in several countries. Data about potential risks associated with the third booster dose in pwMS, such as vaccine-triggered disease exacerbations, are still scarce. OBJECTIVE To investigate whether the administration of a third booster dose of mRNA COVID-19 vaccines was associated with an increased risk of short-term disease reactivation in a large cohort of pwMS. METHODS We retrospectively selected 1265 pwMS who received a third booster dose of an mRNA COVID-19 vaccine. Demographic and clinical data were collected, including the presence, number and characteristics of relapses in the 60 days prior to and after the third booster dose. RESULTS In the selected cohort, the relapse rate in the two months after administration of the third booster dose of mRNA COVID-19 vaccines did not increase when compared with the prior two months. Indeed, the percentage of pwMS experiencing relapses in the 60 days following the administration of the third booster dose was 2.1%, similar to the percentage recorded in 60 days prior to vaccination, which was 1.9%. CONCLUSIONS The third booster dose of mRNA COVID-19 vaccines appeared to be safe for pwMS.
Collapse
Affiliation(s)
- Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Umbria, Italy.
| | - Diana Ferraro
- Dipartimento di Neuroscienze, Ospedale Civile di Baggiovara, Azienda Ospedaliera-Università di Modena, Modena, Italy
| | - Paolo Ragonese
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Prosperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Giorgia Teresa Maniscalco
- Centro Regionale Sclerosi Multipla, Dipartimento di Neurologia e Stroke Unit, Ospedale "A. Cardarelli", Naples, Italy
| | - Antonio Gallo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Cavalla
- Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lorena Lorefice
- Centro Sclerosi Multipla, Dipartimento di Scienze Mediche e di Sanità Pubblica, ASL Cagliari, Università di Cagliari, Ospedale Binaghi, Cagliari, Italy
| | - Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Di Sabatino
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Umbria, Italy
| | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche dell'Università di Torino, AOU San Luigi Gonzaga Di Orbassano, Orbassano, Italy
| | - Clara Guaschino
- Neurologia ad Indirizzo Neuroimmunologico-Centro Sclerosi Multipla, ASST Valle Olona, Gallarate, Italy
| | - Marta Radaelli
- U.O.C. Di Neurologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Fabio Buttari
- Dipartimento di Medicina dei Sistemi, Università di Tor Vergata, Rome, Italy
| | - Alice Laroni
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Scienze Materno-Infantili, Università di Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Massimiliano Calabrese
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Simona Malucchi
- SCDO Neurologia - CRESM, AOU San Luigi Gonzaga, Orbassano, Italy
| | - Damiano Paolicelli
- Dipartimento di Biomedicina Traslazionale e Neuroscienze, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Ospedale Universitario SS Annunziata, Chieti, Italy
| | - Valentina Tomassini
- Centro Sclerosi Multipla, Clinica Neurologica, Ospedale Universitario SS Annunziata, Chieti, Italy
- Istituto di Tecnologie Avanzate Biomediche (ITAB), Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, Facoltà di Medicina e Chirurgia, Università di Chieti-Pescara "G. D'Annunzio", Chieti, Italy
| | - Roberta Lanzillo
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Degli Studi Federico II, Naples, Italy
| | - Marcello Moccia
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- Centro Sclerosi Multipla, Ospedale Universitario Federico II, Naples, Italy
| | - Claudio Solaro
- Unità di Neurologia, E.O. Ospedali Galliera, Genoa, Italy
| | - Eleonora Cocco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Centro Regionale Sclerosi Multipla, ASL Cagliari, ATS Sardegna, Università di Cagliari, Cagliari, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| |
Collapse
|
5
|
Fneish F, Frahm N, Peters M, Ellenberger D, Haas J, Löbermann M, Pöhlau D, Röper AL, Schilling S, Stahmann A, Temmes H, Paul F, Zettl UK. Occurrence and Risk Factors of Relapse Activity after Vaccination against COVID-19 in People with Multiple Sclerosis: 1-Year Follow-Up Results from a Nationwide Longitudinal Observational Study. Vaccines (Basel) 2023; 11:1859. [PMID: 38140262 PMCID: PMC10747540 DOI: 10.3390/vaccines11121859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Several studies reported post-SARS-CoV-2-vaccination (PV) symptoms. Even people with multiple sclerosis (PwMS) have concerns about disease activity following the SARS-CoV-2 vaccination. We aimed to determine the proportion of PwMS with PV relapses, the PV annualized relapse rate (ARR), the time from vaccination to subsequent relapses, and identify sociodemographic/clinical risk factors for PV relapses. PwMS were surveyed several times at baseline and four follow-ups as part of a longitudinal observational study regarding the safety and tolerability of the SARS-CoV-2 vaccination. The inclusion criteria for this analysis were age ≥18 years, ≥1 SARS-CoV-2 vaccination, and ≥1-year observation period since initial vaccination. Of 2466 PwMS, 13.8% reported PV relapses (mostly after second [N = 147] or booster vaccination [N = 145]) at a median of 8.0 (first/third quantile: 3.55/18.1) weeks PV, with the shortest period following initial vaccination (3.95 weeks). The ARR was 0.153 (95% confidence interval: 0.138-0.168), with a median observation period since initial vaccination of 1.2 years. Risk factors for PV relapses were younger age, female gender, moderate-severe disability levels, concurrent autoimmune diseases, relapsing-remitting MS courses, no DMT, and relapses within the year prior to the first vaccination. Patients' health conditions before/during initial vaccination may play a more important role in PV relapse occurrence than vaccination per se.
Collapse
Affiliation(s)
- Firas Fneish
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Niklas Frahm
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, 18147 Rostock, Germany;
| | - Melanie Peters
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Gesellschaft für Versorgungsforschung mbH (Society for Health Care Research [GfV]), German MS Registry, 30171 Hannover, Germany
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Micha Löbermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University Medical Center of Rostock, 18057 Rostock, Germany;
| | - Dieter Pöhlau
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Anna-Lena Röper
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Sarah Schilling
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), German MS Registry, 30171 Hannover, Germany; (F.F.); (M.P.); (D.E.); (A.-L.R.); (S.S.); (A.S.)
| | - Herbert Temmes
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German MS Society Federal Association [DMSG]), 30171 Hannover, Germany; (J.H.); (D.P.); (H.T.)
| | - Friedemann Paul
- Experimental and Clinical Research Center, Joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, The Charité Medical Faculty, Campus Berlin-Buch, 13125 Berlin, Germany;
- Department of Neurology, Charité—Universitätsmedizin, 10117 Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin, 10117 Berlin, Germany
| | - Uwe K. Zettl
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, 18147 Rostock, Germany;
| |
Collapse
|