ABSTRACT
Background and aims: B-lymphocytes play an important role in the pathophysiology of MS. As with other anti- CD20-antibodies, there is evidence that Rituximab may be effective and safe in this disease. Methods: Retrospective study in MS patients treated with Rituximab between 2017-2021. Demographic, clinical, radiologic and laboratory variables were analyzed. Results: 45 patients were included (60% males, mean age 48.3±8;84.4% presented SPMS;median baseline EDSS 6.0, IQR 4-6.5;mean follow-up 22.69±8.75 months). After one year of treatment, there was a significant reduction of relapses (ARR 0.51 vs 0.1, p=0.002), new/enlarged T2 lesion (60% vs 10%, p<0.001) or gadolinium-enhancing lesions (40% vs 0%, p<0.001) on MRI. EDSS, T25FWT, 9HPT or SDMT did not significally change. 33.3% presented confirmed disability progression (CDP). 56.4% achieved NEDA-3. Retreatment was guided by B-lymphocytes count. Mean B-cells count was 285.7, 1.553, 4.456, 54.35, 10.47 at baseline, 3, 6, 9 and 12 months, respectively. Mean time to retreatment was 9.05±3.14 months. Lipidospecific IgM-OCB were associated with CDP (adjusted OR 6.33, p=0.047). At first dose, 31.1% presented an infusion reaction, with fewer cases with retreatment. 28.8% presented infections of any kind, including three cases of Covid19 (only one case of severe infection was reported). No cases of hypogammaglobulinemia were reported. Conclusion: B-lymphocytes count guiding retreatment with Rituximab among patients with MS may favor a good safety profile, while being effective in reducing inflammatory activity. CDP was associated with lipidospecific IgM-OCB.
Subject(s)
COVID-19 , Olfaction Disorders , Taste Disorders , COVID-19/complications , COVID-19/diagnosis , Case-Control Studies , Humans , Olfaction Disorders/diagnosis , Olfaction Disorders/virology , Pandemics , Polymerase Chain Reaction , SARS-CoV-2 , Smell , Taste Disorders/diagnosis , Taste Disorders/virologyABSTRACT
BACKGROUND AND PURPOSE: Specific respiratory tract infections, including COVID-19, may cause smell and/or taste disorders (STDs) with increased frequency. The aim was to determine whether new-onset STDs are more frequent amongst COVID-19 patients than influenza patients. METHOD: This was a case-control study including hospitalized patients of two tertiary care centres. Consecutive patients positive for COVID-19 polymerase chain reaction (cases) and patients positive for influenza polymerase chain reaction (historical control sample) were assessed during specific periods, employing a self-reported STD questionnaire. RESULTS: Seventy-nine cases and 40 controls were included. No significant differences were found in basal features between the two groups. New-onset STDs were significantly more frequent amongst cases (31, 39.2%) than in the control group (5, 12.5 %) [adjusted odds ratio 21.4 (2.77-165.4, P = 0.003)]. COVID-19 patients with new-onset STDs were significantly younger than COVID-19 patients without STDs (52.6 ± 17.2 vs. 67.4 ± 15.1, P < 0.001). Amongst COVID-19 patients who presented STDs, 22 (70.9%) recalled an acute onset and it was an initial manifestation in 11 (35.5%). Twenty-five (80.6%) presented smell disorders (mostly anosmia, 14, 45.2%) and 28 (90.3%) taste disorders (mostly ageusia, 14, 45.2%). Only four (12.9 %) reported concomitant nasal obstruction. The mean duration of STD was 7.5 ± 3.2 days and 12 patients (40%) manifested complete recovery after 7.4 ± 2.3 days of onset. CONCLUSION: New-onset STDs were significantly more frequent amongst COVID-19 patients than influenza patients; they usually had an acute onset and were commonly an initial manifestation. The use of STD assessment in anamnesis as a hint for COVID-19 and to support individuals' self-isolation in the current epidemic context is suggested.