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Sancho-López A, Ruiz-Antorán B, Iglesias Hernangómez T, Ramírez-García A, Gómez-Estévez I, Sanabria-Cabrera J, Llop Rius R, Pedrós C, Campodonico D, Jiménez-Jorge S, García Luque A, Costa Frossad França L, Montané E, Aldea-Perona A, Téllez Lara N, Bosch Ferrer M, Rodriguez Jiménez C, Bonilla-Toyos E, Sabín Muñoz J, Avendaño-Solá C, Blasco Quilez MR. The Need for the Closer Monitoring of Novel Drugs in MS: A Siponimod Retrospective Cohort Study (Realhes Study). J Clin Med 2023; 12:6471. [PMID: 37892611 PMCID: PMC10607533 DOI: 10.3390/jcm12206471] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/07/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Severe cases of lymphopenia have been reported during siponimod clinical trials, which may negatively impact its benefit/risk profile. OBJECTIVE We aimed to evaluate the incidence of lymphopenia following the initiation of siponimod treatment in clinical practice. The secondary objectives included the analysis of factors predisposing to and the clinical relevance of lymphopenia events. METHODS In this multicenter retrospective cohort study, information collected from the medical records of 129 patients with MS from 15 tertiary hospitals in Spain who initiated treatment with Siponimod were followed-up for at least 3 months, including at least one lymphocyte count evaluation per patient. RESULTS Of the 129 patients, 121 (93.6%) reported lymphopenia events, including 110 (85.3%) with grade ≤ 3 and 11 (8.5%) with grade 4 lymphopenia, higher than those reported in the pivotal clinical trial (73.3% and 3.3% for grade ≤ 3 and grade 4 lymphopenia, respectively). The study included an unexpectedly high proportion of male subjects (72.9%), which might have led to an underestimation of the actual magnitude of the risk. CONCLUSIONS In this study, the incidence and severity of lymphopenia after starting siponimod treatment were higher than those reported in previous clinical trials. Therefore, our results reinforce the need for the closer monitoring of novel MS drugs in clinical practice, as well as larger and longer follow-up studies to properly characterize this risk.
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Affiliation(s)
- Arantxa Sancho-López
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Majadahonda, Spain; (A.S.-L.); (A.R.-G.); (C.A.-S.)
| | - Belén Ruiz-Antorán
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Majadahonda, Spain; (A.S.-L.); (A.R.-G.); (C.A.-S.)
| | | | - Almudena Ramírez-García
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Majadahonda, Spain; (A.S.-L.); (A.R.-G.); (C.A.-S.)
| | - Irene Gómez-Estévez
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, 28040 Madrid, Spain;
- Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Judith Sanabria-Cabrera
- Clinical Pharmacology Department, Hospital Universitario Virgen de la Victoria, IBIMA_Plataforma BIONAND, Universidad de Málaga, 29071 Malaga, Spain; (J.S.-C.); (E.B.-T.)
- Platform for Clinical Research and Clinical Trials IBIMA, Plataforma ISCIII de Investigación Clínica, 28029 Madrid, Spain
| | - Roser Llop Rius
- Clinical Pharmacology Department, Hospital Universitari de Bellvitge, 08907 l’Hospitalet de Llobregat, Spain;
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Barcelona University, 08007 l’Hospitalet de Llobregat, Spain
| | - Consuelo Pedrós
- Unidad de Farmacología Clínica, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Diana Campodonico
- Clinical Pharmacology Department, Hospital Universitario La Princesa, 28006 Madrid, Spain;
| | - Silvia Jiménez-Jorge
- CTU-HUVR (Clinical Trials Unit-Hospital Universitario Virgen del Rocío), 41013 Sevilla, Spain;
| | - Amelia García Luque
- Department of Clinical Pharmacology, Defense Central Hospital, 28047 Madrid, Spain;
- Department of Biomedical Sciences (Pharmacology Section), University of Alcalá (IRYCIS), 28801 Madrid, Spain
| | | | - Eva Montané
- Clinical Pharmacology Department, Hospital Universitario Germans Trias i Pujol, 08916 Barcelona, Spain;
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain;
| | - Ana Aldea-Perona
- Clinical Pharmacology Department, Hospital del Mar Barcelona, Clinical Research Unit Research Hospital del Mar Research Institute, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain;
| | - Nieves Téllez Lara
- Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | - Montserrat Bosch Ferrer
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain;
- Department of Clinical Pharmacology, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Clinical Pharmacology Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Consuelo Rodriguez Jiménez
- Clinical Trials Unit, Pharmacology Department, Complejo Hospitalario Universitario e Canarias, 38320 Santa Cruz de Tenerife, Spain;
| | - Elvira Bonilla-Toyos
- Clinical Pharmacology Department, Hospital Universitario Virgen de la Victoria, IBIMA_Plataforma BIONAND, Universidad de Málaga, 29071 Malaga, Spain; (J.S.-C.); (E.B.-T.)
- Platform for Clinical Research and Clinical Trials IBIMA, Plataforma ISCIII de Investigación Clínica, 28029 Madrid, Spain
| | - Julia Sabín Muñoz
- Neurology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Majadahonda, Spain; (J.S.M.); (M.R.B.Q.)
| | - Cristina Avendaño-Solá
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Majadahonda, Spain; (A.S.-L.); (A.R.-G.); (C.A.-S.)
| | - María Rosario Blasco Quilez
- Neurology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, 28222 Majadahonda, Spain; (J.S.M.); (M.R.B.Q.)
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García-Pérez J, Bermejo M, Ramírez-García A, Torre Tarazona HEDL, Cascajero A, Osa MCDL, Jiménez P, Gómez MA, Calonge E, Sancho-López A, Payares-Herrera C, Acero RL, Vicente-Izquierdo L, Avendaño-Solá C, Alcamí J, Pérez-Olmeda M, Díez-Fuertes F. Longer intervals between SARS-CoV-2 infection and mRNA-1273 doses improve the neutralization of different variants of concern. J Med Virol 2023; 95:e28679. [PMID: 36929737 DOI: 10.1002/jmv.28679] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/12/2022] [Revised: 02/20/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
The humoral immune response against SARS-CoV-2 variants of concern elicited by vaccination was evaluated in COVID-19 recovered individuals (Rec) separated 1-3 months (Rec2m) or 4-12 months (Rec9m) post infection and compared to the response in naïve participants. Antibody-mediated immune responses were assessed in 66 participants by three commercial immunoassays and a SARS-CoV-2 lentiviral-based pseudovirus neutralization assay. Immunoglobulin (Ig) levels against SARS-CoV-2 spike were lower in naïve participants after two doses than in Rec after a single dose (p<0.05). After two doses in Rec, levels of total Ig to receptor binding domain (RBD) were significantly increased in Rec9m compared to Rec2m (p<0.001). The neutralizing potency observed in Rec9m was consistently higher than in Rec2m against VOCs Alpha, Beta, Delta, and BA.1 sublineage of Omicron with 2.2-2.8-fold increases. Increasing the interval between SARS-CoV-2 infection and the vaccination with mRNA-based vaccines to more than 3 months generates a more efficient heterologous humoral immune response against VOCs by allowing enough time to mount a strong recall memory B cell response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Javier García-Pérez
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Mercedes Bermejo
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Almudena Ramírez-García
- Clinical Pharmacology Department. Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Hospital Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - Humberto Erick De La Torre Tarazona
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Almudena Cascajero
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María Castillo de la Osa
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Paloma Jiménez
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid
| | - Marta Aparicio Gómez
- Prevention of Occupational Risks Department. Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Hospital Puerta de Hierro Segovia de Arana, Madrid
| | - Esther Calonge
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.,Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aránzazu Sancho-López
- Clinical Pharmacology Department. Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Hospital Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - Concepción Payares-Herrera
- Clinical Pharmacology Department. Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Hospital Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - Rocio Layunta Acero
- Clinical Pharmacology Department. Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Hospital Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - Laura Vicente-Izquierdo
- Clinical Pharmacology Department. Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Hospital Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - Cristina Avendaño-Solá
- Clinical Pharmacology Department. Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Hospital Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - José Alcamí
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.,Infectious Diseases Unit, IBIDAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mayte Pérez-Olmeda
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.,Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Francisco Díez-Fuertes
- AIDS Immunopathogenesis Unit. Instituto de Salud Carlos III, Madrid.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Ramírez-García A, Lozano Jiménez S, Darnaude Ximénez I, Gil Cacho A, Aguado-Noya R, Segovia Cubero J. Pericarditis after administration of the BNT162b2 mRNA COVID-19 vaccine. Rev Esp Cardiol (Engl Ed) 2021; 74:1120-1122. [PMID: 34364831 PMCID: PMC8282480 DOI: 10.1016/j.rec.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 10/27/2022]
Affiliation(s)
- Almudena Ramírez-García
- Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
| | - Sara Lozano Jiménez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Ignacio Darnaude Ximénez
- Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Alberto Gil Cacho
- Servicio de Urgencias, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Ramón Aguado-Noya
- Servicio de Urgencias, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Javier Segovia Cubero
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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Ramírez-García A, Lozano Jiménez S, Darnaude Ximénez I, Gil Cacho A, Aguado-Noya R, Segovia Cubero J. [Pericarditis after administration of the BNT162b2 mRNA COVID-19 vaccine]. Rev Esp Cardiol 2021; 74:1121-1123. [PMID: 34149145 PMCID: PMC8196309 DOI: 10.1016/j.recesp.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Almudena Ramírez-García
- Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Sara Lozano Jiménez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Ignacio Darnaude Ximénez
- Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Alberto Gil Cacho
- Servicio de Urgencias, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Ramón Aguado-Noya
- Servicio de Urgencias, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Javier Segovia Cubero
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
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