Ocrelizumab extended interval dosing in multiple sclerosis during SARS-CoV-2 pandemic: a real-world experience

Background: During COVID-19 pandemic second line disease modifying therapies (DMTs) for multiple sclerosis (MS), have been frequently postponed because of the epidemiological situation and the lack of safety information. Objective(s): To evaluate clinical implications of delaying ocrelizumab dosing in MS. Aim(s): To assess the occurrence of clinical relapses, disability worsening and neuroradiological disease activity in MS patients receiving extended interval dosing ocrelizumab in a real-world setting. Method(s): Data from 90 MS patients (65 RRMS, 25 PPMS) who underwent ocrelizumab dose delay have been retrospectively obtained: in particular MS history, neurological examinations, white blood cells count (particularly lymphocyte subsets) and neuroradiological data have been collected. Result(s): Enrolled patients have been followed up for a mean of 9.5+/-2.8 months after ocrelizumab dose delay (mean dosing interval 7.67+/-0.79 months). None of our 65 RRMS patients had clinical relapses, nor rapid disability worsening has been experienced by the PPMS cohort. Pre-infusion CD19+/CD20+ lymphocyte subset was available in 75/90 patients, with 18/75 patients showing significant B cells repopulation (defined as CD19+/CD20+ >= 1.0%). MRI data were available in 47/90 patients, with 5/47 patients showing evidence of neuroradiological disease activity (mild in all reported cases and in the absence of any correlation with B cells repopulation). Conclusion(s): Our data suggest ocrelizumab dose delay is generally safe in MS patients. Experiences during COVID-19 pandemic could be a starting point towards a more personalized scheduling of ocrelizumab therapy.

HIV Services and Outcomes During the COVID-19 Pandemic - United States, 2019-2021.

Increasing HIV testing, preexposure prophylaxis (PrEP), and antiretroviral therapy (ART) are pillars of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative, with a goal of decreasing new HIV infections by 90% by 2030.* In response to the COVID-19 pandemic, a national emergency was declared in the United States on March 13, 2020, resulting in the closure of nonessential businesses and most nonemergency health care venues; stay-at-home orders also limited movement within communities (1). As unemployment increased during the pandemic (2), many persons lost employer-sponsored health insurance (3). HIV testing and PrEP prescriptions declined early in the COVID-19 pandemic (4-6); however, the full impact of the pandemic on use of HIV prevention and care services and HIV outcomes is not known. To assess changes in these measures during 2019-2021, quarterly data from two large U.S. commercial laboratories, the IQVIA Real World Data - Longitudinal Prescription Database (IQVIA),† and the National HIV Surveillance System (NHSS)§ were analyzed. During quarter 1 (Q1)¶ 2020, a total of 2,471,614 HIV tests were performed, 190,955 persons were prescribed PrEP, and 8,438 persons received a diagnosis of HIV infection. Decreases were observed during quarter 2 (Q2), with 1,682,578 HIV tests performed (32% decrease), 179,280 persons prescribed PrEP (6% decrease), and 6,228 persons receiving an HIV diagnosis (26% decrease). Partial rebounds were observed during quarter 3 (Q3), with 2,325,554 HIV tests performed, 184,320 persons prescribed PrEP, and 7,905 persons receiving an HIV diagnosis. The proportion of persons linked to HIV care, the number who were prescribed ART, and proportion with a suppressed viral load test (<200 copies of HIV RNA per mL) among those tested were stable during the study period. During public health emergencies, delivery of HIV services outside of traditional clinical settings or that use nonclinical delivery models are needed to facilitate access to HIV testing, ART, and PrEP, as well as to support adherence to ART and PrEP medications.

Telemedicine in/outside the pandemic: A survey about satisfaction of this tool in a cohort of multiple sclerosis patients and their neurologists

Background: Telemedicine is a live communication between patients and physicians through different technological tools. It became fundamental during COVID-19 pandemic to keep on taking care of patients in more medical fields than before. Given the chance for telemedicine to become a pivotal part of neurological routine practice, we investigated patients and neurologists satisfaction about this tool. Objectives: This survey aimed to understand satisfactionabout telemedicine during pandemic and its possible use in the future outside pandemic Methods: We administered a brief survey to a cohort of Multiple Sclerosis (MS) patients and their neurologists at MS center of San Raffaele Hospital, Milan. Demographic and clinical data (EDSS, treatment) were collected. Results: 151 patients filled out the survey: 75% females;mean age 42.2yy (18-73);median EDSS 1.5 (0-7). Treatments were almost equally distributed across first and second-line drugs (10% interferon, 10% glatiramer acetate, 14% teriflunomide, 22% dimethylfumarate, 23% fingolimod, 3% cladribine, 8% alemtuzumab, 10% ocrelizumab). 87% of patients appreciated telemedicine during pandemic;10% had a positive opinion but with a need for traditional evaluations, while 3% were not satisfied. Considering the possible routine use of telemedicine outside the pandemic, 82% firmly stated the importance of traditional evaluations. In particular, 44% would alternate in person and remote visits, while 38% strongly preferred traditional ones. Among the latters, the main reasons were the need for human empathy with the neurologist and the feeling that traditional evaluations may lead to better clinical outcomes. The remaining 18% would always use telemedicine except in the case of acute events. Neurologists and residents (n=18) were inquired about telemedicine: no one would use it as the only tool, 33% would alternate it with traditional practice and 67% would use it only in special contexts. Conclusions: In our survey, both patients and neurologists recognized the importance of telemedicine during a pandemic. Patients more than physicians seemed ready to use it in everyday clinical practice. These data may be biased by a still ongoing patients fear and physicians lack of confidence in this multifaceted tool. The pandemic spurred the development of institutional telematic platforms capable of providing legal protection and traceability of visits and communication between patients and physicians. So far, we can conclude that telemedicine is a useful tool to overcome space-time limits, giving the best care to all patients in any condition. However, it cannot replace but only integrate traditional medicine.