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Allen-Philbey K, Stennett A, Begum T, Johnson AC, MacDougall A, Green S, Dobson R, Giovannoni G, Gnanapavan S, Marta M, Smets I, Turner BP, Baker D, Mathews J, Schmierer K. Did it hurt? COVID-19 vaccination experience in people with multiple sclerosis. Mult Scler Relat Disord 2022; 65:104022. [PMID: 35816953 PMCID: PMC9250705 DOI: 10.1016/j.msard.2022.104022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
Background Current guidelines recommend vaccination against SARS-CoV2 for people with multiple sclerosis (pwMS). The long-term review of the safety and effectiveness of COVID-19 vaccines in pwMS is limited. Methods Service re-evaluation. PwMS using the MS service at Barts Health National Health Service Trust were sent questionnaires via email to report symptoms following first and second COVID-19 vaccinations (n = 570). A retrospective review of electronic health records was conducted for clinical and safety data post-vaccination(s); cut-off was end of September 2021. Separate logistic regressions were carried out for symptoms experienced at each vaccination. Two sets of regressions were fitted with covariates: (i) Disease-modifying therapy type and (ii) patient characteristics for symptoms experienced. Results 193/570 pwMS responded. 184 pwMS had both vaccinations. 144 received the AZD1222 and 49 the BNT162b2 vaccine. 87% and 75% of pwMS experienced any symptoms at first and second vaccinations, respectively. The majority of symptoms resolved within a short timeframe. No severe adverse effects were reported. Two pwMS subsequently died; one due to COVID-19 and one due to aspiration pneumonia. Males were at a reduced risk of reporting symptoms at first vaccination. There was evidence that pwMS in certain treatment groups were at reduced risk of reporting symptoms at second vaccination only. Conclusions Findings are consistent with our preliminary data. Symptoms post-vaccination were similar to the non-MS population and were mostly temporary. It is important to inform the MS community of vaccine safety data.
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Affiliation(s)
- K Allen-Philbey
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Stennett
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK; Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, UK
| | - T Begum
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A C Johnson
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A MacDougall
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, UK
| | - S Green
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - R Dobson
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK; Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, UK
| | - G Giovannoni
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK; Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, UK
| | - S Gnanapavan
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Marta
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - I Smets
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - B P Turner
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Baker
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK
| | - J Mathews
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Schmierer
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK.
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Allen-Philbey K, Stennett A, Begum T, Johnson AC, Dobson R, Giovannoni G, Gnanapavan S, Marta M, Smets I, Turner BP, Baker D, Mathews J, Schmierer K. Experience with the COVID-19 AstraZeneca vaccination in people with multiple sclerosis. Mult Scler Relat Disord 2021; 52:103028. [PMID: 34049216 PMCID: PMC8129799 DOI: 10.1016/j.msard.2021.103028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 02/09/2023]
Abstract
Background Some people with multiple sclerosis (pwMS) are at increased risk of severe Coronavirus disease 19 (COVID-19) and should be rapidly vaccinated. However, vaccine supplies are limited, and there are concerns about side-effects, particularly with the ChAdOx1nCoV-19 (AstraZeneca) vaccine. Objectives To report our first experience of pwMS receiving the AstraZeneca vaccine. Methods Service evaluation. pwMS using the MS service at Barts Health NHS Trust were sent questionnaires to report symptoms following vaccination. Results Thirty-three responses were returned, 29/33 pwMS received a first dose of AstraZeneca vaccine, the remaining four received a first dose of BioNTech/Pfizer vaccine. All but two patients (94%) reported any symptoms including a sore arm (70%), flu-like symptoms (64%), fever (21%), fatigue (27%), and headache (21%). In more than 2/3 patients, symptoms lasted up to 48 hours, and with the exception of two pwMS reporting symptom duration of 10 and 12 days, respectively, symptoms in the remainder resolved within seven days. No severe adverse effects occurred. Conclusions pwMS report transient symptoms following AstraZeneca vaccination, characteristics of which were similar to those reported in the non-MS population. Symptoms may be more pronounced in pwMS due to the temperature-dependent delay in impulse propagation (Uhthoff's phenomenon) due to demyelination.
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Affiliation(s)
- K Allen-Philbey
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - A Stennett
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - T Begum
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - A C Johnson
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - R Dobson
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom
| | - G Giovannoni
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom
| | - S Gnanapavan
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - M Marta
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - I Smets
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - B P Turner
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - D Baker
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom
| | - J Mathews
- Pharmacy, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - K Schmierer
- The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
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Mateo-Casas M, Reyes S, O'Toole EA, De Trane S, Yildiz O, Allen-Philbey K, Mathews J, Baker D, Giovannoni G, Schmierer K. Severe skin reactions associated with cladribine in people with multiple sclerosis. Mult Scler Relat Disord 2020; 43:102140. [PMID: 32454296 DOI: 10.1016/j.msard.2020.102140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To report three cases of severe skin reactions in patients treated with cladribine for multiple sclerosis. METHODS Case study. RESULTS Patients developed severe rash 3-192 days after receiving cladribine. All were effectively treated with steroids and antihistamines. Additional doses of cladribine were administered after pretreatment with steroids and anti-histamines. One patient developed mild recurrence following re-exposure, which resolved within three days, whilst another patient tolerated re-exposure without further adverse reaction. CONCLUSION Severe skin reactions, well described in patients receiving cladribine for treatment of haematological conditions, may occur in patients treated with this compound for multiple sclerosis. Neurologists need to be aware of this rare, but significant adverse reaction. Re-exposure may be safe with standard pre-treatment against allergic reactions.
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Affiliation(s)
- M Mateo-Casas
- The Blizard Institute (Neuroscience, Surgery & Trauma), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - S Reyes
- The Blizard Institute (Neuroscience, Surgery & Trauma), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - E A O'Toole
- The Blizard Institute (Cell Biology & Cutaneous Research), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - S De Trane
- The Blizard Institute (Neuroscience, Surgery & Trauma), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - O Yildiz
- The Blizard Institute (Neuroscience, Surgery & Trauma), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Allen-Philbey
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Mathews
- Pathology and Pharmacy, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Baker
- The Blizard Institute (Neuroscience, Surgery & Trauma), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - G Giovannoni
- The Blizard Institute (Neuroscience, Surgery & Trauma), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Schmierer
- The Blizard Institute (Neuroscience, Surgery & Trauma), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK.
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Yildiz O, Mao Z, Adams A, Dubuisson N, Allen-Philbey K, Giovannoni G, Malaspina A, Baker D, Gnanapavan S, Schmierer K. Disease activity in progressive multiple sclerosis can be effectively reduced by cladribine. Mult Scler Relat Disord 2018; 24:20-27. [PMID: 29860198 DOI: 10.1016/j.msard.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/18/2018] [Accepted: 05/11/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Evidence suggests people with non-relapsing deteriorating ("progressive") multiple sclerosis (pwPMS) may benefit from disease-modifying immune therapy (DMT). However, only one such treatment (ocrelizumab) has been licensed and is highly restricted to pwPMS suffering from the primary progressive phenotype. The difficulties assessing treatment outcome in pwPMS is one important reason for the lack of respective DMT. The concentration of neurofilaments in the cerebrospinal fluid (CSF) provides a biomarker of neuro-axonal damage, and both neurofilament light (NfL) and heavy chain (NfH) levels have been used as outcome indices and to guide treatment choices. METHODS We report on two pwPMS, who were treated with subcutaneous cladribine undergoing CSF NfL testing, alongside MRI and clinical follow-up, before and after treatment. RESULTS Cladribine treatment was well tolerated without any side effects. CSF NfL after treatment revealed significant reduction (by 73% and 80%, respectively) corroborating the MRI detectable drop in disease activity. Disability mildly progressed in one, and remained stable in the other pwPMS. CONCLUSIONS pwPMS with detectable disease activity (MRI, elevated NfL) should be considered for DMT. NfL appears to be a sensitive index of treatment effect in pwPMS, and may be a useful outcome in clinical trials targeting this patient group. Over and above its licensed indication (relapsing MS), cladribine may be an effective treatment option for pwPMS.
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Affiliation(s)
- O Yildiz
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom; Clinical Board: Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Z Mao
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom; Department of Neurology, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China; Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen, China
| | - A Adams
- Department of Neuroradiology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - N Dubuisson
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - K Allen-Philbey
- Clinical Board: Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - G Giovannoni
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom; Clinical Board: Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - A Malaspina
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom; Clinical Board: Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - D Baker
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - S Gnanapavan
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom; Clinical Board: Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - K Schmierer
- The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom; Clinical Board: Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
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Alvarez-Gonzalez C, Allen-Philbey K, Mathews J, Turner BP, Baker D, Gnanapavan S, Marta M, Giovannoni G, Schmierer K. TREATING MULTIPLE SCLEROSIS WITH CLADRIBINE. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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