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1.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-343179

ABSTRACT

Objective: Currently, there is no data available on SARS-CoV-2 vaccine responses in pediatric-onset multiple sclerosis (POMS) and little is known about the course of SARS-CoV-2 infection in this age group. We therefore investigated humoral immune responses after Covid-19 vaccination and/or infection in POMS. Methods: We retrospectively analyzed seroconversion rates and SARS-CoV-2 specific antibody levels in 30 POMS and 1 pediatric CIS patient treated with either no disease-modifying therapy (no DMT), immunomodulatory DMT (IM-DMT), or immunosuppressive DMT (IS-DMT) from two Austrian MS centers. Results: Median age at MS onset was 15.39 years (IQR 1.97). Median age at first COVID-19 vaccination was 17.43 years (IQR 2.76). After two vaccine doses, seroconversion (≥0.8 BAU/ml) was reached in 25/28 patients (89.3%). All patients with no DMT or IM-DMT generated robust immune responses to vaccination (seroconversion: no DMT: 6/6, IM-DMT: 7/7 (100%);median titers: no DMT: 2075 BAU (IQR 1268.50), IM-DMT: 2500 BAU (IQR 0)). In the IS-DMT group seroconversion was achieved in 12/14 patients (80%), median titers were 50.8 BAU (IQR 254.63). Titers were significantly higher in no DMT versus IS-DMT (p=0.012) and in IM-DMT versus IS-DMT (p=0.001). Infection with SARS-CoV-2 occurred in 11 of 31 patients and symptoms were mild in all cases. One relapse occurred after infection, but no relapses were documented after vaccination. Conclusions: Generally, mRNA vaccinations were well tolerated in POMS patients with and without DMT. Immune response was significantly reduced in patients treated with IS-DMT. No unexpected adverse events or relapses related to vaccinations were observed.

2.
Annals of Clinical and Experimental Neurology ; 16(2):70-77, 2022.
Article in Russian | Scopus | ID: covidwho-2026892

ABSTRACT

The safety of pathogenetic therapy for multiple sclerosis (MS) is a crucial aspect of the therapeutic strategy during the COVID-19 pandemic. Based on our own data, obtained during the study of MS pathogenesis and safety analysis of MS disease-modifying therapies (DMTs), we hereby suggest a classification of DMTs side effects, based on their type, development, and direction of action. There is a need to thoroughly analyse adverse events caused by pathogenetic therapy, with a balanced assessment of the direct vs. adverse effects of immunosuppressive drugs. Based on available literature, in the article, data on the effect of DMTs with various mechanisms of action on severe coronavirus infection are systematized. Interferon-β and glatiramer acetate are the safest drugs to use during the COVID-19 pandemic. Teriflunomide, dimethyl fumarate, natalizumab, ocrelizumab, fingolimod, alemtuzumab, and cladribine should be used with caution. Drugs with a minor systemic immunosuppressant effect (e.g. natalizumab) and selective immunosuppressants (e.g. ocrelizumab) are safer than drugs that cause non-selective depletion of T and B cells. It must be stressed that the risk of MS exacerbation and progression due to untimely prescription or cessation of pathogenetic therapy can significantly exceed the potential risk of COVID-19. Long-term safety monitoring is required for DMTs during the COVID-19 pandemic and when the epidemiological situation stabilizes. © 2022 Sovero Press Publishing House. All rights reserved.

3.
Journal of Rehabilitation Sciences and Research ; 8(4):158-163, 2021.
Article in English | Scopus | ID: covidwho-2026439

ABSTRACT

Background: COVID-19 seems to have a major impact on physical activity behaviors, especially for people with Multiple Sclerosis (MS) who have health conditions. Methods: This study was a narrative review. Six databases, namely PubMed, ISI Web of Knowledge, Scopus, Google Scholar, Science Direct, and ProQuest, were search for relevant published studies. Results: Healthcare providers and organizations advise people to stay at home, but this does not mean that they should be inactive. Self-isolation has an adverse effect on behavior activities and mental health in people with MS. Physical activity can act as medicine for people with MS, as it helps reduce stress, anxiety, and fatigue while improving balance, muscle strength, flexibility, and quality of life. Conclusion: People with MS are recommended to perform activities such as whole-body chair exercises with moderate intensity at least 150 minutes per week according to the level of the individual's ability. © 2021 The Authors.

4.
Archives of Neuropsychiatry / Noropsikiatri Arsivi ; 59(3):226-231, 2022.
Article in English | CINAHL | ID: covidwho-2026436

ABSTRACT

Introduction: Various restrictions due to the coronavirus infection have affected working life globally. People with multiple sclerosis (pwMS) have several difficulties in social life, patient follow-up, and receiving treatments. In this study, we aimed to evaluate the experiences of pwMS during the COVID-19 pandemic. Method: We developed a 50-question survey aiming to determine fears, anxieties, and the problems experienced by patients regarding their diseases and social lives during the COVID-19 pandemic. The questionnaire was released online via the Turkish MS Society website, local MS societies websites, and social media accounts. Only the answers of the patients who filled out the questionnaire completely were evaluated. Results: In total, 6008 patients took the survey, and 3255 of them completed the questionnaire. Among all, 378 patients (11.6%) were positive for COVID-19. The most common COVID-19-related symptom was fatigue (48.4%). The routine medical follow-up was interrupted in 61.4% and the medication was discontinued in 14% of the patients. Approximately 25% of the patients reported different symptoms related to relapse activity. The main concern of the patients related to the COVID-19 pandemic was the disruption of the health of the ones they loved. Among all the patients, 4.4% lost their jobs. Conclusion: Our data showed that the COVID-19 pandemic strongly affected the working lives of pwMS. Also, the pandemic changed the attitudes of patients and neurologists. Therefore, the long-term effects of the COVID-19 pandemic on disease approach, patient follow-up, social conditions, and working life should be monitored.

5.
Current Neurology ; 21(3):137-137–142, 2021.
Article in Polish | ProQuest Central | ID: covidwho-2025790

ABSTRACT

Vaccination is the best strategy for preventing most infectious diseases. Along with adhering to the principles of prevention, vaccines are particularly important in the time of the COVID-19 pandemic. There is evidence that multiple sclerosis increases the risk of developing infections, and the immunosuppressive and immunomodulating medications taken by multiple sclerosis patients may increase this risk. No evidence has been found that vaccination increases the risk of developing MS or a relapse. It is believed that people with multiple sclerosis can be vaccinated safely, and it is a mistake not to have a vaccination only because of being diagnosed with multiple sclerosis. When determining the indications for vaccination, as well as when selecting vaccines and determining the optimal time for their administration, the epidemiological situation of the patient’s region of residence and the type of disease-modifying therapy should be taken into account. The vaccination-related restrictions mainly apply to alemtuzumab, fingolimod, ocrelizumab and cladribine. The article reviews the rules for vaccinating multiple sclerosis patients depending on the type of vaccine and the disease-modifying therapy used. Recommendations for vaccination against the SARS-CoV-2 infection in multiple sclerosis patients are also taken into account.

6.
Current Neurology ; 21(3):131-131–136, 2021.
Article in Polish | ProQuest Central | ID: covidwho-2025789

ABSTRACT

Multiple sclerosis patients are by definition more susceptible to infections, which dependents on the use of disease-modifying treatments. Depending on the mechanism of action, individual disease-modifying treatments carry different risks. As a result, patients require an individualised approach to initiating and continuing new treatments. This problem became very important during the COVID-19 pandemic. In the case of drugs with different mechanisms of action on the immune system, the impact of therapy on susceptibility to SARS-CoV-2 infections and the course of COVID-19 should be considered. Based on the risk/ benefit analysis for the patient, individual therapies have been assigned recommendations: 1) low-risk therapies (glatiramer acetate, interferons, dimethyl fumarate, teriflunomide) – discontinuation of therapy and delay of treatment initiation is not recommended;2) moderate-risk therapies (fingolimod, natalizumab, ocrelizumab, cladribine) – require caution, individual risk/benefit assessment, risk analysis of multiple sclerosis symptom exacerbation after drug discontinuation;3) high-risk therapies (alemtuzumab, mitoxantrone, haematopoietic stem cells transplantation) – treatment initiation is not recommended, administration of subsequent doses requires extreme caution. The article reviews the recommendations and publications from the last 2 years, taking into account the changing views on the treatment of multiple sclerosis in the time of COVID-19 pandemic.

7.
Pathogens ; 11(8):864, 2022.
Article in English | ProQuest Central | ID: covidwho-2023963

ABSTRACT

Epstein–Barr virus (EBV) was discovered in 1964 in the cell line of Burkitt lymphoma and became first known human oncogenic virus. EBV belongs to the Herpesviridae family, and is present worldwide as it infects 95% of people. Infection with EBV usually happens during childhood when it remains asymptomatic;however, in adults, it can cause an acute infection known as infectious mononucleosis. In addition, EBV can cause wide range of tumors with origins in B lymphocytes, T lymphocytes, and NK cells. Its oncogenicity and wide distribution indicated the need for vaccine development. Research on mice and cultured cells as well as human clinical trials have been in progress for a few decades for both prophylactic and therapeutic EBV vaccines. The main targets of the vaccines are EBV envelope glycoproteins such as gp350 and EBV latent genes. The long wait for the EBV vaccine is due to the complexity of the EBV replication cycle and the wide range of its host cells. Although some strategies such as the use of dendritic cells and recombinant Vaccinia viral vectors have shown success, ongoing clinical trials using mRNA-based vaccines as well as new delivery systems as nanoparticles are yet to show the best choice of vaccine target and its production strategy.

8.
Frontiers in Immunology ; 13, 2022.
Article in English | Web of Science | ID: covidwho-2022726

ABSTRACT

Monitoring immune responses to SARS-CoV-2 vaccination and its clinical efficacy over time in Multiple Sclerosis (MS) patients treated with disease-modifying therapies (DMTs) help to establish the optimal strategies to ensure adequate COVID-19 protection without compromising disease control offered by DMTs. Following our previous observations on the humoral response one month after two doses of BNT162b2 vaccine (T1) in MS patients differently treated, here we present a cross-sectional and longitudinal follow-up analysis six months following vaccination (T2, n=662) and one month following the first booster (T3, n=185). Consistent with results at T1, humoral responses were decreased in MS patients treated with fingolimod and anti-CD20 therapies compared with untreated patients also at the time points considered here (T2 and T3). Interestingly, a strong upregulation one month after the booster was observed in patients under every DMTs analyzed, including those treated with fingolimod and anti-CD20 therapies. Although patients taking these latter therapies had a higher rate of COVID-19 infection five months after the first booster, only mild symptoms that did not require hospitalization were reported for all the DMTs analyzed here. Based on these findings we anticipate that additional vaccine booster shots will likely further improve immune responses and COVID-19 protection in MS patients treated with any DMT.

9.
Neurology neuroimmunology & neuroinflammation ; 9(6), 2022.
Article in English | MEDLINE | ID: covidwho-2021402

ABSTRACT

BACKGROUND AND OBJECTIVES: Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is needed. METHODS: Clinician-reported demographic/clinical data from 27 countries were aggregated into a data set of 5,648 patients with suspected/confirmed coronavirus disease 2019 (COVID-19). COVID-19 severity outcomes (hospitalization, admission to intensive care unit [ICU], requiring artificial ventilation, and death) were assessed using multilevel mixed-effects ordered probit and logistic regression, adjusted for age, sex, disability, and MS phenotype. DMTs were individually compared with glatiramer acetate, and anti-CD20 DMTs with pooled other DMTs and with natalizumab. RESULTS: Of 5,648 patients, 922 (16.6%) with suspected and 4,646 (83.4%) with confirmed COVID-19 were included. Male sex, older age, progressive MS, and higher disability were associated with more severe COVID-19. Compared with glatiramer acetate, ocrelizumab and rituximab were associated with higher probabilities of hospitalization (4% [95% CI 1-7] and 7% [95% CI 4-11]), ICU/artificial ventilation (2% [95% CI 0-4] and 4% [95% CI 2-6]), and death (1% [95% CI 0-2] and 2% [95% CI 1-4]) (predicted marginal effects). Untreated patients had 5% (95% CI 2-8), 3% (95% CI 1-5), and 1% (95% CI 0-3) higher probabilities of the 3 respective levels of COVID-19 severity than glatiramer acetate. Compared with pooled other DMTs and with natalizumab, the associations of ocrelizumab and rituximab with COVID-19 severity were also more pronounced. All associations persisted/enhanced on restriction to confirmed COVID-19. DISCUSSION: Analyzing the largest international real-world data set of people with MS with suspected/confirmed COVID-19 confirms that the use of anti-CD20 medication (both ocrelizumab and rituximab), as well as male sex, older age, progressive MS, and higher disability are associated with more severe course of COVID-19.

10.
Genes (Basel) ; 13(8)2022 Jul 24.
Article in English | MEDLINE | ID: covidwho-2023336

ABSTRACT

Multiple sclerosis (MS) is an autoimmune neurodegenerative disorder of the central nervous system that presents heterogeneous clinical manifestations and course. It has been shown that different immune checkpoints, including Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4), can be involved in the pathogenesis of MS. CTLA-4 is a critical regulator of T-cell homeostasis and self-tolerance and represents a key inhibitor of autoimmunity. In this scopingreview, we resume the current preclinical and clinical studies investigating the role of CTLA-4 in MS with different approaches. While some of these studies assessed the expression levels of CTLA-4 on T cells by comparing MS patients with healthy controls, others focused on the evaluation of the effects of common MS therapies on CTLA-4 modulation or on the study of the CTLA-4 blockade or deficiency in experimental autoimmune encephalomyelitis models. Moreover, other studies in this field aimed to discover if the CTLA-4 gene might be involved in the predisposition to MS, whereas others evaluated the effects of treatment with CTLA4-Ig in MS. Although these results are of great interest, they are often conflicting. Therefore, further studies are needed to reveal the exact mechanisms underlying the action of a crucial immune checkpoint such as CTLA-4 in MS to identify novel immunotherapeutic strategies for MS patients.


Subject(s)
CTLA-4 Antigen , Encephalomyelitis, Autoimmune, Experimental , Multiple Sclerosis , Animals , Autoimmunity/genetics , CTLA-4 Antigen/genetics , Encephalomyelitis, Autoimmune, Experimental/genetics , Encephalomyelitis, Autoimmune, Experimental/pathology , Humans , Multiple Sclerosis/drug therapy , Multiple Sclerosis/genetics , T-Lymphocytes
11.
Journal of Neurology, Neurosurgery and Psychiatry ; 93(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2020218

ABSTRACT

Multiple sclerosis (MS) is an inflammatory condition affecting the central nervous system. Infection is a major consideration in the MS population due to its relevance to several stages of the disease process:(i) it has been suggested that infective processes may be ‘triggering’ or aetiological factors for MS, (ii) concurrent infection is known to exacerbate symptoms in MS, (iii) people with MS are at higher risk of infection when compared to the general population, and this risk is exaggerated in those receiving disease modifying therapies (DMTs).This guidance document was developed by specialists in the field of MS, Immunology, Infectious Disease and Pharmacy. A modified Delphi approach was used to develop clinically relevant, evidence-based consensus guidelines to help physicians navigate the complex interaction between DMTs and infectious diseases.We focus on specific risks predisposing people with MS to infection and how to manage these risks. We also provide recommendations on how to screen for, prevent, and manage infection in this population, in particular tuberculosis, progressive multifocal leukoencephalopathy, hepatitis B, human papillomavirus, herpetic and other opportunistic infections. We also discuss vaccination and the COVID-19 pandemic in people on DMTs.

12.
Clinical and Experimental Neuroimmunology ; 13(3):131-132, 2022.
Article in English | Academic Search Complete | ID: covidwho-2019177

ABSTRACT

Anti-mAbs treatments have revolutionized the treatment of MS and NMOSD. Over the last few years, there has been remarkable progress in the treatment of multiple sclerosis (MS) and optic neuromyelitis optica spectrum disorder (NMOSD), especially with the approval of new and advanced treatment options such as multiple antimonoclonal antibodies (mAbs). This poses several questions, such as whether B-cell-depleting options such as rituximab increases the risk of COVID-19 or its severity, if COVID-19 vaccine is effective, and when to initiate anti-mAb treatment. [Extracted from the article] Copyright of Clinical & Experimental Neuroimmunology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

13.
Annals of the Rheumatic Diseases ; 81:963, 2022.
Article in English | EMBASE | ID: covidwho-2009067

ABSTRACT

Background: Many countries are promoting booster SARS-CoV-2 vaccination campaigns as the COVID-19 pandemic continues. Incremental short-term adverse events after two SARS-CoV-2 vaccinations have been reported in healthy individuals.1,2 However, data on incremental short-term adverse events in patients with various immune-mediated infammatory diseases (IMIDs) after repeated SARS-CoV-2 vaccination is scarce. Objectives: We report risk factors for short-term adverse events in IMID patients after SARS-CoV-2 vaccination. Methods: Self-reported daily questionnaires on adverse events in the frst seven days after SARS-CoV-2 vaccination were obtained from individuals participating in an ongoing prospective multi-arm multicenter cohort study on SARS-CoV-2 vaccination in patients with various IMIDs in the Netherlands (T2B! immunity after SARS-CoV-2). Clinically relevant adverse events were defned as systemic adverse advents lasting longer than two days or hindering daily activities. Adjusted relative risks for developing clinically relevant adverse events were calculated using a logistic mixed-effects model. Results: Data of 2081 patients and 178 healthy controls were obtained. Infammatory bowel disease (N:480), Multiple sclerosis (N:343) and Rheumatoid arthritis (N:266) were the largest disease groups. Adjusted relative risks for relevant adverse events are presented in Figure 1. Third vaccination was not associated with increased risk on adverse events when compared to a second vaccination (aRR: 0.93 95% CI: 0.84-1.02). Patients with IMIDs were at increased risk for developing adverse events after vaccination when compared to controls (aRR: 1.16 95% CI: 1.01-1.34). Female sex (aRR 1.43 95% CI: 1.32-1.56), age below 50 (aRR 1.14 95% CI: 1.06-1.23) and a preceding SARS-CoV-2 infection (aRR: 1.14 95% CI: 1.01-1.29) were also associated with increased risk of adverse events following vaccination. Allergic reactions and hospital admission were uncommon (0.67% and 0.19% respectively);7.4% and 6.8% of patients reported adverse events impacting daily life on day seven after second and third vaccination, respectively. Data on increase in disease activity of the IMID following vaccination are currently being investigated. Conclusion: A third SARS-CoV-2 vaccination was not associated with an increased risk on short-term clinically relevant adverse events when compared to a second vaccination. Although patients with IMIDs may be slightly more at risk to develop adverse events after SARS-CoV-2 vaccination, most adverse events were transient and disappeared within seven days. This message should reassure IMID patients who are hesitant on booster vaccination. Data on potential IMID fare-ups after vaccination will follow.

14.
Annals of the Rheumatic Diseases ; 81:933-934, 2022.
Article in English | EMBASE | ID: covidwho-2008880

ABSTRACT

Background: COVID-19 vaccination strategies have evolved with increasing vaccine availability and emerging vaccine safety data. While data on immuno-genicity and safety of COVID vaccination strategies exists, there is limited data for people with immune mediated infammatory diseases (IMIDs) such as infam-matory arthritis (IA), systemic autoimmune rheumatic disease (SARD), infam-matory bowel disease (IBD) and multiple sclerosis (MS). Objectives: In IMID patients treated with homologous or heterogeneous COVID vaccines, to compare post vaccine IMID disease activity and COVID antibody responses. Methods: Between March 2021 and Dec 2021, patients with IA (n= 70;77% rheumatoid arthritis), SARD (n=82;70% lupus), IBD (n= 92;40% crohn's), and MS (n= 71;77% RRMS) self-reported COVID illness and exposure risks, and disease activity prior to and 1 month post both COVID-19 vaccinations (V1 and V2). Disease activity was assessed by the Systemic Lupus Activity Questionnaire (SLAQ) for SARDs, the RAPID-3 and RA fate index for IA, the IBD Symptoms Inventory-short form (IBDSI) and IBD fare index for IBD and the 25 meter walk and 9 hole peg test and Expanded Disability Status Scale (EDSS) for MS. Patient reported fare state was assessed using the relevant questions these indices (SLAQ 'Have you had a fare?';RA Flare index 'Are you in a fare?';IBD fare 'My IBD is sometimes to continously active'). Disease activity and serum anti-spike, anti-receptor binding domain (RBD) and anti-nucleocapsid (NC) IgG antibody titers at 30 days post V2 were compared across vaccine courses and to age-sex matched vaccinated blood donor controls (CNTS). Results: Patients were predominantly female (79.7%), with a mean (standard deviation-sd) age of 56 (15) years;8% had suspected or diagnosed COVID-19 illness;1.2% positive anti-NC (Table 1). For all IMIDS, the majority received mRNA vaccines-BNT162b2 (BNT) or mRNA1273 (V1 74%;V2 97%;) the rest received ChAdOx1 viral vector vaccines;71% received homologogous vaccines (ChAdOx1-ChAdOx n=6;BNT-BNT n=174;mRNA1271-mRNA1273 n=21;ChAdOx1-BNT n=36;ChAdOx1-mRNA1273 n=30;BNT-mRNA1273 n=15;mRNA1273-BNT n=3;other n=4). For most IMIDs, disease activity was similar before and after each vaccination. Post V2 disease activity did not differ between homologous versus heterologous vaccines nor by vaccine type (RAPID3;SLAQ, 25 meter walk and 9 hole peg test and EDSS overall and subscales, IBDSI overall and subscales all p=NS). In 254 IMIDs, most seroconverted (anti-spike 86%;anti-RBD 96%). Seroconversion rates for CNTS were 98.1% for anti-Spike and 3.5% for anti-NC. Antibody titers were higher following homologous mRNA (BNT or mRNA12723) than homologous vector vaccine (Figure 1). For IMIDs primed with ChAdOx vector vaccine, boosting with BNT or mRNA1273 generated similarly increased anti-Spike and anti-RBD titers. Conclusion: Heterologous COVID vaccination improves seroconversion rates following a viral vector vaccine and does not lead to disease fare in most IMID patients. While data is needed to assess vaccine effectiveness, duration of immu-nogenicity and effects of subsequent vaccination, this work supports mixing COVID vaccines for IMID patients.

15.
Annals of the Rheumatic Diseases ; 81:917, 2022.
Article in English | EMBASE | ID: covidwho-2008873

ABSTRACT

Background: Rituximab (RTX) induces rapid, usually complete and prolonged depletion of circulating B cells, and also hypogammaglobulinemia in some patients. There are limited data regarding the risk of severe infection events (SIE) when initiating or continuing rituximab in patients with acquired hypogammaglob-ulinemia, especially in patients suffering from autoimmune diseases (ADs) other than rheumatoid arthritis (RA) (1). Objectives: To describe the risk of severe infectious events (SIE) following initiation (rituximab-naïve patients [RNP]) or continuation of RTX therapy (rituxi-mab-continuing patients [RCP]) in patients suffering from severe ADs other than RA and acquired hypogammaglobulinemia. Methods: We conducted a single-center retrospective cohort study at the University Hospital of Toulouse (France) between 2010 and 2018. Patients were included if they had received at least one dose of RTX in the year following the evidence of hypogammaglobulinemia (defned as gammaglobulins [GG]≤ 6g/L on serum protein electrophoresis) in the setting of ADs other than RA. The primary outcome was the occurrence of a SIE within 2 years after the date of frst RTX infusion (T0) prescribed after the evidence of hypogammaglobulinemia. SIE were infections either fatal or requiring hospitalization. Results: We included 121 patients (37 RNP and 84 RCP): 48 had ANCA-as-sociated vasculitis (AAV), 48 multiple sclerosis (MS, n=41) or neuromyeli-tis optica (NMO, n=7), and 21 another severe AD. RTX was prescribed as induction therapy in 39 patients and as maintenance therapy in 82;112/121 patients were followed for 2 years. Mean GG level were 5.5 g/L (IQ25-75 4.6-5.7) at T0, 5.5 g/L (IQ25-75 5-6.4) at one year, 5.7g/L (IQ25-75 4.8-6.1) at two years and 8 patients had a decrease of their GG level below 4g/L. Ten patients received immunoglobulin replacement therapy (IGRT) mostly after infection (n=6). Twenty-six patients (23.2%) had at least one SIE during follow-up: 12.8 % in the MS/NMO group with a 2-year incidence at 6.9 (3.1-15.3) per 100 person-years, 29.5 % in the AAV group with a 2-year incidence at 18.3 (9.3-20.1) per 100 person-years, 33.3 % in the 'other ADs' group with a 2-year incidence at 22.2 (10.6-46.5) per 100 person-years. Infection was opportunistic in 8 patients (33.3%) and 4 died from SIE. Risk factors of SIE at T0 were male gender (61.5% vs. 39.5% p<0.05), lung disease (65.4% vs. 37.2% p=0.01), renal failure (59.1% vs. 28.6% p=0.01), a higher Charl-son comorbidity index (p=0.001), a previous treatment by cyclophospha-mide (53.8% vs. 30.2%;p=0.03), ≥ 5 mg/d prednisone (69.2% vs. 33.7%, p=0.003), lack of pneumococcal vaccination (61.5% vs 31.4%, p=0.01). GG level was 5.3 g/l [4.1-5.6] in the 'SIE' group vs 5.6 g/l [4.8-5.8] in the 'no SIE' group (p=0.04). Incidence of SIE was 46% and 20.2% among patients with GG< 4 g/L or GG≥ 4 g/L, respectively (p=0.07). No multivariable analysis provided reliable results. Conclusion: Our study provides useful information for clinicians considering initiating or continuing rituximab therapy in patients with acquired hypogammaglob-ulinemia before Sars-Cov2 era. Prospective studies are necessary to improve the knowledge on outcome of patients treated by rituximab despite low immu-noglobulins levels. Prophylactic IGRT may be appropriate in higher risk patients, especially if the GG level is below 4 G/L.

16.
Journal of Neuroimaging ; 32(4):767-768, 2022.
Article in English | EMBASE | ID: covidwho-2008752

ABSTRACT

Background and Purpose: Balo's concentric sclerosis (BCS) is a rare inflammatory demyelinating disorder of the central nervous system (CNS) characterized pathologically and radiologically by concentric lamella of alternating demyelinated and partially myelin-preserved white matter. Whether BCS is a variant of multiple sclerosis (MS) or a distinct entity remains debatable. Here, we report an unusual case of MS complicated by Balo's lesions, post-Coronavirus disease 2019 (COVID-19), focusing on the evolution ofMRI findings. Methods: Single-case study. Results: The patient is a 42-year-old woman with relapsing-remitting MS diagnosed at age of 19 who was treated with teriflunomide for the past 5 years. She developed a febrile illness and arthralgia for a week;however, COVID-19 testing was deferred. Two weeks later, she presented with vertigo followed by profound right-hemiparesis, gait impairment, and encephalopathy. Cerebrospinal fluid analysis revealed a protein of 56 mg/dl, increased immunoglobulinG(IgG) index, and>l10 unique oligoclonal bands. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG was detected in serum, but viral ribonucleic acid was absent in the CSF. BrainMRI demonstrated, for the first time, several Balo-like and tumefactive lesions, with contrast enhancement and restricted diffusion. She received plasma exchange alternating with pulse steroids, yet was left with ataxic hemiparetic gait. She was later switched to an anti-CD20 monoclonal antibody therapy. Followup brain MRIs showed continuous regression of the tumefactive and Balo-like lesions. Conclusion: This case adds to the emerging spectrum of COVID-19- associated radiological findings regarding inflammatory demyelination in the CNS. It remains unknown whether potential neurotropism of SARS-CoV-2 or parainfectious mechanisms might have contributed to the fulminant disease in our patient.

17.
Multiple Sclerosis and Related Disorders ; : 104156, 2022.
Article in English | ScienceDirect | ID: covidwho-2007967

ABSTRACT

Background The Coronavirus 19 pandemic has raised new relevant questions regarding the management of patients with multiple sclerosis (pwMS) treated with different immunosuppressive and immunomodulant drugs. In most Covid-19 outcomes analyses, due to the small available sample size, patients treated with cladribine were grouped with patients treated with other treatments. Methods Three major databases (PubMed, Scopus and Web of Science) and the most recent MS congress libraries were searched for extracting original articles on Covid-19 and multiple sclerosis. The key inclusion criteria were the presence of data on pwMS treated with cladribine and with documented positivity for Covid-19. The quality of the included studies was evaluated using a modified version of the Dutch Cochrane center critical review checklist proposed by MOOSE. A common-effect meta-analysis was used for estimating the pooled proportion of patients with severe events (hospitalizations, pneumonia, ICU admissions and deaths) and heterogeneity was assessed by the I2 statistic. Results 13 articles were included in the analysis and the median quality of the articles reached a level of 4. The selected studies included 5138 patients with COVID-19, of whom 107 (2.1%) were treated with cladribine. Pooled estimates of hospitalization and death were 9.36% and 0% for patients treated with cladribine, 14.98% and 2.66% for pwMS under other treatments. Conclusion These results indicate that pwMS treated with cladribine are not at a greater risk of developing a severe form of Covid-19, Registration The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022329464)

18.
Journal of Neuroimaging ; 32(4), 2022.
Article in English | EMBASE | ID: covidwho-2006765

ABSTRACT

The proceedings contain 31 papers. The topics discussed include: brain abscess appearing 20 years post craniotomy;postoperative diffusion restriction in the proximal optic nerve: optic neuropathy or central retinal artery occlusion?;magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: a systematic review;bilateral internuclear ophthalmoplegia caused by unilateral infarction;neuroaspergillosis in a patient with chronic lymphocytic leukemia as progressively worsening ischemic infarct;neuroimaging in mitochondrial short-chain enoyl-coa hydratase 1 deficiency: a progressive encephalomyelopathy starting in utero;childhood-onset neurodegeneration with brain atrophy: imaging findings of a rare diagnosis;multiple sclerosis associated with Balo-like lesions post-coronavirus disease 2019;and within-subject reproducibility of quantitative proton density mapping.

19.
Frontiers in Pediatrics ; 10, 2022.
Article in English | Web of Science | ID: covidwho-2005893

ABSTRACT

Central nervous system (CNS) involvement in monogenic autoinflammatory disorders (AID) is increasingly recognized and can be life threatening. Therefore, a low threshold to consider CNS disease should be maintained in patients with systemic inflammation. Hyperinflammation is also a key feature of severe acute COVID-19 and post COVID-19 entities such as multisystem inflammatory syndrome in children. Like AID, COVID-19 patients can present with severe CNS involvement. The impact of COVID-19 on AID and CNS involvement in particular is still obscure, nevertheless dreaded. In the current review, we synthesize the spectrum of CNS manifestations in monogenic AID. We explore common pathophysiological and clinical features of AID and COVID-19. Moreover, we assess the impact of immune dysregulation associated with SARS-CoV-2 infections and post COVID-19 hyperinflammation in AID. The striking commonalities found between both disease entities warrant caution in the management of AID patients during the current pandemic.

20.
Transfusionsmedizin ; 12(03):157-162, 2022.
Article in English | Web of Science | ID: covidwho-2004809

ABSTRACT

For more than two years the whole world is suffering from the COVID-19 pandemic. Before introduction of vaccination strategies the administration of fresh frozen plasma from convalescent donors seemed a promising therapeutic approach, especially if administered during the early phase of disease. The outcomes in multicenter trials on huge cohorts, however, did not meet the expectations. This is one reason why German guidelines do not recommend the use of convalescent plasma. One explanation could be varying and often low concentrations of COVID-19 antibodies in a majority of plasma units at the beginning of plasma applications, which could account for the lack of a convincing clinical efficacy. Therefore, we follow a strategy to selectively collect and concentrate human immunoglobulins using immunoadsorption as the method of antibody donation.

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