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Multiple Sclerosis Journal ; 27(3 SUPPL):17, 2021.
Article in English | EMBASE | ID: covidwho-1582622


Background: Since the Covid-19 pandemic started, it has been necessary to adapt our clinical practice to limit physical contact. We have established a virtual/presential rehabilitation program (VPR) in patients with EDSS ≤6.5. Methods: Our aim was to compare the effectiveness of the VPR with the previous face-to-face rehabilitation program (PR). Retrospective data were obtained from all patients with an EDSS≤6.5 who were admitted between September and December of 2019 and 2020. All patients were attended 3 times per week for 4 months. In the 2019 group the sessions were PR based, whereas in the 2020 group patients received a VPR, with one face-to-face session plus 2 virtual sessions. Outcomes (obtained pre and post rehabilitation programs) compared between VPR and PR groups were: 10MWT, Tinnetti Test (TT) and Berg Balance Scale (BBS). A minimally clinical significant difference was established for each test: 20% for 10MWT, 3 points for BBS and 1 point for TT. Results: One hundred and forty people were included in the groups VPR (n=80) / PR (N=60). For VPR and PR groups, mean age was 51.45y (SD10.71) / 54.65y (SD11.19) and mean EDSS 4.62 (SD1.45) / 4.64 (SD1.46). All clinical outcomes demonstrated statistically significant improvements pre-post intervention in both groups. Comparing VPR vs PR scores, test didn't show differences using a U of Mann-Whitney for independent samples: BBS 54.2%/44.1% (p =0.27);10MWT 36.7%/22.0% (p =0.13) and TT 40.7%/37.3% (p =0.72). Conclusions: No differences were observed in the effectiveness of VPR versus PR in any of the tests. The VPR program could be a useful tool for patients with an EDSS≤6.5, as the VPR provides a series of subjective benefits (ease of occupational and family life, reduction of fatigue caused by long journeys) while maintaining effectiveness. Further studies with improved designs are warranted to confirm these findings.

Multiple Sclerosis Journal ; 27(2 SUPPL):758-759, 2021.
Article in English | EMBASE | ID: covidwho-1496076


Introduction: Information about how SARS-CoV-2 specific humoral and cellular response is modified by disease-modifying therapies (DMTs) is scarce. Objective: To investigate humoral and cellular responses to SARS-CoV-2 and factors for presenting them in a Barcelona cohort of pwMS. Methods: Retrospective cohort study of adult unvaccinated PwMS with confirmed COVID-19 with at least one SARS-CoV-2 antibody (Ab) determination included from February 2020 to May 2021 and followed until May 2021. Demographic, clinical and laboratory data were obtained. Humoral SARS-CoV-2 response was measured with commercial chemiluminescence immunoassays targeting specific Ab against spike (IgG-S) and nucleocapsid proteins (Ig-N), as per clinical practice. SARS-CoV-2 specific T-cell response was studied in 42 selected pwMS according to DMT by a whole blood Interferon-Gamma (IFN-y) Release Immunoassay. Humoral and cellular response was assesed using a logistic regression model corrected for age, sex, comorbidities, MS form, expanded disability status scale, DMT, COVID-19 severity and PCR result. Results: 145 pwMS were enrolled (mean age 46.8 years;64.1% female;18.6% progressive forms, 20.7% untreated, 22.8% on anti-CD20s therapies and 56.6% on other DMTs). Humoral and cellular tests were performed from 0.3 to 13.1 months after COVID-19. 121(83.5%) presented positive Ab (57.6% anti-CD20 therapy, 90.2% other DMTs, 93.3% untreated). Untreated patients presented higher Ig-N titres (34.3[128.8]) compared to those with anti-CD20s (0.08[0.13], p<0.01), and other DMTs (19.55[42.92], p<0.01). Humoral response persisted over 6 months in 12/12 untreated, 9/22 with anti-CD20s and 22/28 with other DMTs (p=0.068). 31/42(73.8%) presented cellular response (81.0% anti- CD20, 62.5% other DMTs, 80.0% untreated), with similar levels of IFN-y levels among DMTs. 5/12(41.7%) anti-CD20-treated PwMS with negative Ab presented cellular response. In the multivariate analysis, humoral response decreased in anti-CD20 therapy (OR 0.08[95% CI,0.01-0.55]) and was associated with male sex (OR 3.59[1.02-12.68]). Cellular response was associated with seropositivity (OR13.0[1.29-130.4]), but can be present even in the absence of Ab. Conclusions: Humoral response is altered by DMTs, specially in anti-CD20-treated PwMS. Cellular response is associated with seropositivity but can be present in anti-CD20-treated PwMS even in the absence of Ab. Both can be detected up to 13.1 months after COVID-19.

Multiple Sclerosis Journal ; 27(2 SUPPL):769-770, 2021.
Article in English | EMBASE | ID: covidwho-1496075


Background: Information about humoral and cellular responses to SARS-CoV-2 vaccination in patients with Multiple Sclerosis (PwMS) and other autoimmune diseases (AID) is scarce. Objective: To determine humoral and cellular responses after SARS-CoV-2 vaccination in PwMS and anti-CD20-treated patients with other AID. Methods: Ongoing prospective study performed in two Catalan MS centres from February 2021. Unvaccinated adult pwMS and other anti-CD20-treated AID were recruited. Demographic, clinical and laboratory data were obtained. Whole blood samples were obtained before and 30-90 days after vaccination. The humoral response to SARS-CoV-2 was qualitatively and quantitatively measured before and after vaccination with commercial chemiluminescence immunoassays targeting SARS-CoV-2 antibodies against spike (TrimericS, IgG anti-S) and nucleocasid proteins (Elecsys, Ig anti-N). In 150 selected patients according to diseasemodifying therapy (DMT), the SARS-CoV-2 specific T-cell response was assessed after vaccination by a whole blood Interferon-Gamma Release immuno Assay (IGRA) that uses two Qiagen proprietary mixes of SARS-CoV-2 S protein (Ag.1 and Ag.2) selected to activate both CD4 and CD8 T cells. Results: 457 patients have been enrolled in the study (anti-CD20 therapy n=164, S1P DMTs n=37, natalizumab n=32, cladribine n=29, alemtuzumab n=31, other DMTs n=129, no DMT n=35). Participants characteristics are: mean age 48.1 years (SD 12.0), 69% female, 422 pwMS (29.4% progressive forms) and 35 with other AID, disease duration 13.9 years (IQR 14.1), median EDSS 3.0 (IQR 3.0). 450 have been fully vaccinated (94.2% mRNA vaccine). Pre-vaccination samples were collected 0.33 days (SD 0.5) before the first vaccine dose of which 12 (3.35%) had positive anti S/N immunoglobulin (Ig). As of June 30th, 42 post-vaccination samples have been obtained (1.3 months [SD 0.42] after the 2nd vaccination dose). Positive IgG rates were 44.8% (n=13/29) for CD20s, 100% (8/8) for other DMTs and 100% (4/4) for no DMT. No anti-N Ig were detected. Media titres of anti-S IgG were lower in anti-CD20-treated patients (7.8 [IQR 50.1]) compared to untreated patients (800 [0], p<0.01) or other DMTs (755 [228], p<0.01). Conclusions: Initial results of the study suggest blunted anti-S/N Ig response under anti-CD20 therapy. Knowledge of the cellular response in these patients will be crucial. Data from the cellular study and the completed humoral study will be presented at the meeting.