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1.
Rheumatol Int ; 40(10): 1593-1598, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-713879

ABSTRACT

OBJECTIVE: To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. METHODS: We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. RESULTS: A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization. CONCLUSION: Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.


Subject(s)
Arthritis, Psoriatic/drug therapy , Arthritis, Rheumatoid/drug therapy , Coronavirus Infections/physiopathology , Glucocorticoids/therapeutic use , Hospitalization/statistics & numerical data , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Pneumonia, Viral/physiopathology , Aged , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/therapeutic use , Antiviral Agents/therapeutic use , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/epidemiology , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/epidemiology , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Autoimmune Diseases/epidemiology , Azithromycin/therapeutic use , Betacoronavirus , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Drug Combinations , Female , Humans , Hydroxychloroquine/therapeutic use , Logistic Models , Lopinavir/therapeutic use , Lung Diseases/epidemiology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/epidemiology , Male , Middle Aged , Multivariate Analysis , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Retrospective Studies , Ritonavir/therapeutic use , Severity of Illness Index , Sex Factors , Spain/epidemiology
2.
Rheumatol Int ; 40(10): 1613-1623, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-692201

ABSTRACT

The aim of the research was to further extend current knowledge of whether severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease 2019 (COVID-19) entails a risk for children with various rheumatic diseases under immunosuppressive treatment. Telephone survey was administered by conducting interviews with the parents from May 1, 2020 to May 20, 2020. A message containing a link to the actual questionnaire was sent to their phones simultaneously. The medical records of the patients were reviewed for gathering information about demographic data, clinical follow-up, and treatments. Patients who were followed-up under immunosuppressive treatment (n = 439) were attempted to be contacted. The diagnostic distribution of patients (n = 414) eligible for the study was as follows: juvenile idiopathic arthritis (JIA) (n = 243, 58.7%), autoinflammatory diseases (n = 109, 26.3%), connective tissue diseases (n = 51, 12.3%), and vasculitis (n = 11, 2.7%). In the entire cohort, the mean age was 12 ± 4.7 years, and 54.1% (n = 224) were female. Nine patients have attended the hospital for COVID-19 evaluation, 6 of whom were in close contact with confirmed cases. One patient with seronegative polyarticular JIA, previously prescribed methotrexate and receiving leflunomide during pandemic was identified to be diagnosed with COVID-19. None, including the confirmed case, had any severe symptoms. More than half of the patients with household exposure did not require hospitalization as they were asymptomatic. Although circumstances such as compliance in social distancing policy, transmission patterns, attitude following contact may have influenced the results, immunosuppressive treatment does not seem to pose an additional risk in terms of COVID-19.


Subject(s)
Arthritis, Juvenile/drug therapy , Connective Tissue Diseases/drug therapy , Coronavirus Infections/epidemiology , Hereditary Autoinflammatory Diseases/drug therapy , Immunosuppressive Agents/therapeutic use , Pneumonia, Viral/epidemiology , Vasculitis/drug therapy , Adolescent , Betacoronavirus , Child , Coronavirus Infections/physiopathology , Female , Humans , Male , Pandemics , Pneumonia, Viral/physiopathology , Risk Factors , Severity of Illness Index , Surveys and Questionnaires , Turkey/epidemiology
3.
J Neuroophthalmol ; 40(3): 305-314, 2020 09.
Article in English | MEDLINE | ID: covidwho-682845

ABSTRACT

The initiation and continuation of immune-based therapies to treat and prevent complications of inflammatory neuro-ophthalmologic disorders during the 2019 novel coronavirus (COVID-19) pandemic is the subject of considerable debate. In each case, a treatment decision must be reached based on best clinical practices for the disorder, patient comorbidities, the current state of knowledge about the pathogenesis and infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the utilization of hospital and community resources. Unfortunately, the evidence needed to standardize the decision-making process for each neuro-ophthalmologic disorder is currently absent and is likely to require months or years to develop based on the accrual of robust international data sets. In this article, we review the current understanding of SARS-CoV-2 and COVID-19 complications to provide a framework for approaching the treatment of inflammatory neuro-ophthalmic disorders during the COVID-19 viral pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Eye Diseases/drug therapy , Inflammation/drug therapy , Nervous System Diseases/drug therapy , Pandemics , Pneumonia, Viral/epidemiology , Coronavirus Infections/immunology , Giant Cell Arteritis/drug therapy , Humans , Immunomodulation , Immunosuppressive Agents/therapeutic use , Myasthenia Gravis/drug therapy , Optic Neuritis/drug therapy , Pneumonia, Viral/immunology
4.
Neurologia ; 35(6): 357-362, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-680554

ABSTRACT

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.


Subject(s)
Algorithms , Betacoronavirus/isolation & purification , Coronavirus Infections/prevention & control , Immunosuppressive Agents/administration & dosage , Multiple Sclerosis/drug therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Ambulatory Care , Asymptomatic Diseases , Checklist , Clinical Laboratory Techniques , Contraindications, Drug , Coronavirus Infections/diagnosis , Disease Susceptibility , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Mass Screening/methods , Nasopharynx/virology , Pneumonia, Viral/diagnosis , Polymerase Chain Reaction , Pulse Therapy, Drug , Quarantine , Risk Assessment , Symptom Assessment , Telemedicine
5.
Clin Rheumatol ; 39(9): 2803-2810, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-679748

ABSTRACT

COVID-19 has become a global concern. A large number of reports have explained the clinical characteristics and treatment strategies of COVID-19, but the characteristics and treatment of COVID-19 patient with systemic lupus erythematosus (SLE) are still unclear. Here, we report the clinical features and treatment of the first SLE patient with confirmed COVID-19 pneumonia. This was a 39-year-old woman, diagnosed with SLE 15 years ago, whose overall clinical characteristics (symptoms, laboratory tests, and chest CTs) were similar to those of the general COVID-19 patients. She continued to take the previous SLE drugs (doses of glucocorticoids, hydroxychloroquine, and immunosuppressive agents were not reduced) and was treated with strict antiviral and infection prevention treatment. After the first discharge, she got a recurrence of COVID-19 during her home isolation, and then returned to hospital and continued the previous therapy. Finally, this long-term immune suppressive patient's COVID-19 was successfully cured. The successful recovery of this case has significant reference value for the future treatment of COVID-19 patients with SLE. Key Points • COVID-19 patients with SLE is advocated to continue the medical treatment for SLE. • Hydroxychloroquine may have potential benefits for COVID-19 patients with SLE. • COVID-19 patients with SLE is prone to relapse, and multiple follow-ups are necessary.


Subject(s)
Antirheumatic Agents/therapeutic use , Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Glucocorticoids/therapeutic use , Hydroxychloroquine/therapeutic use , Immunosuppressive Agents/therapeutic use , Lopinavir/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Pneumonia, Viral/drug therapy , RNA, Viral , Ritonavir/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Betacoronavirus , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Drug Combinations , Female , Humans , Lung/diagnostic imaging , Lupus Erythematosus, Systemic/complications , Moxifloxacin/therapeutic use , Mycophenolic Acid/therapeutic use , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Prednisone/therapeutic use , Recurrence , Reverse Transcriptase Polymerase Chain Reaction , Tomography, X-Ray Computed
6.
J Immunother Cancer ; 8(2)2020 07.
Article in English | MEDLINE | ID: covidwho-662488

ABSTRACT

Pneumonitis is a rare but serious adverse event caused by cancer immunotherapy. The diagnosis between COVID-19-induced pneumonia and immunotherapy-induced pneumonitis may be challenging in the era of COVID-19 outbreak. Some clinical symptoms and radiological findings of pneumonitis can be attributed to the coronavirus infection as well as to an immune-related adverse event. Identifying the exact cause of a pneumonitis in patients on treatment with immunotherapy is crucial to promptly start the most appropriate treatment. The proper management of immune checkpoint inhibitors for the risk of pneumonia must take into account a series of parameters. Accurate attention should be payed to symptoms like cough, fever and dyspnea during immunotherapy.


Subject(s)
Antineoplastic Agents, Immunological/adverse effects , Coronavirus Infections/diagnosis , Neoplasms/drug therapy , Pneumonia, Viral/diagnosis , Pneumonia/chemically induced , Pneumonia/diagnosis , Betacoronavirus , CTLA-4 Antigen/antagonists & inhibitors , Clinical Laboratory Techniques , Coronavirus Infections/immunology , Coronavirus Infections/therapy , Diagnosis, Differential , False Negative Reactions , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Lung/diagnostic imaging , Pandemics , Pneumonia/drug therapy , Pneumonia/immunology , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Reverse Transcriptase Polymerase Chain Reaction , Tomography, X-Ray Computed
7.
Gastroenterol Hepatol ; 43(6): 332-347, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-658769

ABSTRACT

The set of measures proposed by SEPD, AEEH, GETECCU and AEG are aimed to help departments in their resumption of usual activity. We have prepared a number of practical recommendations regarding patient management and the stepwise resumption of healthcare activity. These recommendations are based on the sparse, changing evidence available, and will be updated in the future according to daily needs and the availability of expendable materials to suit them; in each department they will be implemented depending upon the cumulative incidence of SARS-CoV-2 infection in each region, and the burden the pandemic has represented for each hospital. The general objectives of these recommendations include: (a)To protect our patients against the risks of infection with SARS-CoV-2 and to provide them with high-quality care. (b)To protect all healthcare professionals against the risks of infection with SARS-CoV-2. (c)To resume normal functioning of our departments in a setting of ongoing risk for infection with SARS-CoV-2.


Subject(s)
Coronavirus Infections/prevention & control , Gastroenterology/organization & administration , Hospital Departments/organization & administration , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Appointments and Schedules , Clinical Laboratory Techniques , Clinical Trials as Topic , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/transmission , Cross Infection/prevention & control , Diagnostic Techniques, Digestive System/instrumentation , Digestive System Diseases/complications , Digestive System Diseases/diagnosis , Digestive System Diseases/therapy , Disinfection , Drug Interactions , Equipment Contamination/prevention & control , Home Care Services/organization & administration , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Liver Transplantation , Mass Screening/organization & administration , Occupational Diseases/prevention & control , Pneumonia, Viral/drug therapy , Pneumonia, Viral/transmission , Protective Devices , Symptom Assessment , Telemedicine/organization & administration , Universal Precautions
8.
BMJ Case Rep ; 13(7)2020 Jul 20.
Article in English | MEDLINE | ID: covidwho-657710

ABSTRACT

Kidney transplant recipients have been reported at a particularly high risk of severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Yet, here we describe a remarkably mild case of COVID-19 in a 62-year-old female who had a kidney transplantation 10 years earlier due to autosomal dominant polycystic kidney disease. The patient was admitted for 1 day; immunosuppressive therapy with tacrolimus and low-dose prednisolone was continued; and the patient recovered successfully without the use of antiviral agents or oxygen therapy. The case demonstrates that kidney transplant recipients are not necessarily severely affected by COVID-19. Withdrawal of immunosuppressive therapy could be associated with poorer outcomes and should not be implemented thoughtlessly.


Subject(s)
Coronavirus Infections/diagnosis , Immunosuppression/adverse effects , Kidney Transplantation/adverse effects , Pneumonia, Viral/diagnosis , Transplant Recipients/statistics & numerical data , Betacoronavirus/isolation & purification , Coronavirus Infections/drug therapy , Coronavirus Infections/virology , Female , Glucocorticoids/therapeutic use , Hospitalization , Humans , Immunosuppressive Agents/therapeutic use , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/virology , Prednisolone/therapeutic use , Tacrolimus/therapeutic use , Treatment Outcome
9.
Nephrol Dial Transplant ; 35(7): 1250-1261, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-652871

ABSTRACT

BACKGROUND: Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies. METHODS: We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate. RESULTS: Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients. CONCLUSIONS: Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Graft Rejection/therapy , Hydroxychloroquine/therapeutic use , Immunosuppression/methods , Kidney Transplantation , Mycophenolic Acid/therapeutic use , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , Allografts , Antimalarials/therapeutic use , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Enzyme Inhibitors/therapeutic use , Female , Graft Rejection/complications , Graft Rejection/epidemiology , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Male , Middle Aged , New York City/epidemiology , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Retrospective Studies , Transplant Recipients
10.
Rev Gastroenterol Mex ; 85(3): 312-320, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-643614

ABSTRACT

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) virus. COVID-19 affected more than 6million persons worldwide in fewer than 4 months, after the report of the first cases in China in December 2019. The relation of the disease caused by SARS-Cov-2 to immunosuppressive treatment used in different gastrointestinal disorders is uncertain, resulting in debate with regard to suspending immunosuppressive therapy to improve infection outcome. Said suspension implies the inherent risk for graft rejection or autoimmune disease exacerbation that can potentially worsen the course of the infection. Based on the presently available evidence, a treatment stance has been established for patients with gastrointestinal diseases that require immunosuppressive therapy.


Subject(s)
Coronavirus Infections/complications , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Liver Diseases/drug therapy , Pancreatic Diseases/drug therapy , Pandemics , Pneumonia, Viral/complications , Humans , Liver Diseases/complications , Liver Transplantation , Pancreas Transplantation , Pancreatic Diseases/complications
11.
Nat Rev Neurol ; 16(9): 493-505, 2020 09.
Article in English | MEDLINE | ID: covidwho-639750

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is concerning for patients with neuroimmunological diseases who are receiving immunotherapy. Uncertainty remains about whether immunotherapies increase the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or increase the risk of severe disease and death upon infection. National and international societies have developed guidelines and statements, but consensus does not exist in several areas. In this Review, we attempt to clarify where consensus exists and where uncertainty remains to inform management approaches based on the first principles of neuroimmunology. We identified key questions that have been addressed in the literature and collated the recommendations to generate a consensus calculation in a Delphi-like approach to summarize the information. We summarize the international recommendations, discuss them in light of the first available data from patients with COVID-19 receiving immunotherapy and provide an overview of management approaches in the COVID-19 era. We stress the principles of medicine in general and neuroimmunology in particular because, although the risk of viral infection has become more relevant, most of the considerations apply to the general management of neurological immunotherapy. We also give special consideration to immunosuppressive treatment and cell-depleting therapies that might increase susceptibility to SARS-CoV-2 infection but reduce the risk of severe COVID-19.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/immunology , Coronavirus Infections/therapy , Immunotherapy/standards , Neuroimmunomodulation/immunology , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Humans , Immunologic Factors/pharmacology , Immunologic Factors/therapeutic use , Immunosuppressive Agents/pharmacology , Immunosuppressive Agents/therapeutic use , Immunotherapy/methods , Neuroimmunomodulation/drug effects , Pandemics
14.
Arq Neuropsiquiatr ; 78(7): 430-439, 2020 07.
Article in English | MEDLINE | ID: covidwho-625980

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism's normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. OBJECTIVE: To discuss strategies to manage those patients. METHODS: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. CONCLUSIONS: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus , Immunosuppressive Agents/therapeutic use , Multiple Sclerosis/drug therapy , Neuromyelitis Optica/drug therapy , Pneumonia, Viral/prevention & control , Betacoronavirus , China/epidemiology , Coronavirus Infections/epidemiology , Disease Susceptibility , Humans , Immunologic Factors/therapeutic use , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Multiple Sclerosis/diagnosis , Neuromyelitis Optica/diagnosis , Pandemics , Pneumonia, Viral/epidemiology , Risk , Telemedicine
15.
J Neurol Sci ; 415: 116935, 2020 08 15.
Article in English | MEDLINE | ID: covidwho-626763

ABSTRACT

Here, in Part II of a duology on the characterization and potential treatment for COVID-19, we characterize the application of an innovative treatment regimen for the prevention of the transition from mild to severe COVID-19, as well as detail an intensive immunotherapy intervention hypothesis. We propose as a putative randomized controlled trial that high-dose methotrexate with leucovorin (HDMTX-LR) rescue can abolish 'PANIC', thereby 'left-shifting' severe COVID-19 patients to the group majority of those infected with SARS-CoV-2, who are designated as having mild, even asymptomatic, disease. HDMTX-LR is endowed with broadly pleiotropic properties and is a repurposed, generic, inexpensive, and widely available agent which can be administered early in the course of severe COVID-19 thus rescuing the critical and irreplaceable gas-exchange alveoli. Further, we describe a preventative treatment intervention regimen for those designated as having mild to moderate COVID-19 disease, but who exhibit features which herald the transition to the severe variant of this disease. Both of our proposed hypothesis-driven questions should be urgently subjected to rigorous assessment in the context of randomized controlled trials, in order to confirm or refute the contention that the approaches characterized herein, are in fact capable of exerting mitigating, if not abolishing, effects upon SARS-CoV-2 triggered 'PANIC Attack'. Confirmation of our immunotherapy hypothesis would have far-reaching ramifications for the current pandemic, along with yielding invaluable lessons which could be leveraged to more effectively prepare for the next challenge to global health.


Subject(s)
Betacoronavirus/drug effects , Clinical Trial Protocols as Topic , Coronavirus Infections/drug therapy , Leucovorin/therapeutic use , Methotrexate/therapeutic use , Pneumonia, Viral/drug therapy , Disease Management , Humans , Immunosuppressive Agents/therapeutic use , Immunotherapy/methods , Pandemics
16.
J Immunother Cancer ; 8(2)2020 07.
Article in English | MEDLINE | ID: covidwho-626611

ABSTRACT

The present review summarizes up-to-date evidence addressing the frequently discussed clinical controversies regarding the use of immune checkpoint inhibitors (ICIs) in cancer patients with viral infections, including AIDS, hepatitis B and C, progressive multifocal leukoencephalopathy, influenza, and COVID-19. In detail, we provide available information on (1) safety regarding the risk of new infections, (2) effects on the outcome of pre-existing infections, (3) whether immunosuppressive drugs used to treat ICI-related adverse events affect the risk of infection or virulence of pre-existing infections, (4) whether the use of vaccines in ICI-treated patients is considered safe, and (5) whether there are beneficial effects of ICIs that even qualify them as a therapeutic approach for these viral infections.


Subject(s)
Immunosuppressive Agents/therapeutic use , Neoplasms/complications , Virus Diseases/therapy , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/immunology , Coronavirus Infections/therapy , Hepatitis B/complications , Hepatitis B/drug therapy , Hepatitis B/immunology , Hepatitis B/therapy , Hepatitis C/complications , Hepatitis C/drug therapy , Hepatitis C/immunology , Hepatitis C/therapy , Humans , Influenza, Human/complications , Influenza, Human/drug therapy , Influenza, Human/immunology , Influenza, Human/therapy , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Virus Diseases/complications , Virus Diseases/drug therapy , Virus Diseases/immunology
17.
Br J Hosp Med (Lond) ; 81(6): 1-3, 2020 Jun 02.
Article in English | MEDLINE | ID: covidwho-614930

ABSTRACT

The National Institute for Health and Care Excellence guidelines advise stopping immunosuppressive drugs for confirmed or suspected COVID-19 patients with autoimmune and inflammatory disorders. This may not be in the patient's best interest, given the potential long-term consequences of not managing chronic conditions, and immunosuppression may even be protective in those affected with COVID-19.


Subject(s)
Coronavirus Infections/immunology , Cytokine Release Syndrome/immunology , Deprescriptions , Immunosuppressive Agents/therapeutic use , Pneumonia, Viral/immunology , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Practice Guidelines as Topic , Prognosis , Severity of Illness Index , United Kingdom/epidemiology
18.
Br J Hosp Med (Lond) ; 81(6): 1-3, 2020 Jun 02.
Article in English | MEDLINE | ID: covidwho-614924

ABSTRACT

Rheumatology patients who are taking immunosuppressants are considered to be at 'high risk' from COVID-19, hence have been self-isolating or shielding. However, they may be protected from the features of hyperinflammation driven by a 'cytokine storm', so may have better clinical outcomes if infected. This editorial discusses whether it may not be necessary to advise these patients to shield.


Subject(s)
Coronavirus Infections/prevention & control , Immunosuppressive Agents/therapeutic use , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Rheumatic Diseases/drug therapy , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/physiopathology , Health Behavior , Humans , Patient Education as Topic , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Protective Factors , Rheumatology , Risk Factors , Severity of Illness Index
20.
Ann Saudi Med ; 40(4): 273-280, 2020.
Article in English | MEDLINE | ID: covidwho-612198

ABSTRACT

In December 2019, a novel coronavirus was identified in patients in Wuhan, China. The virus, subsequently named severe acute respiratory syndrome coronavirus-2, spread worldwide and the disease (coronavirus disease 2019 or COVID-19) was declared a global pandemic by the World Health Organization in March 2020. Older adults and individuals with comorbidities have been reported as being more vulnerable to COVID-19. Patients with chronic liver disease (CLD) have compromised immune function due to cirrhosis and are more susceptible to infection. However, it is unclear if patients with CLD are more vulnerable to COVID-19 and its complications than other populations. The high number of severe cases of COVID-19 has placed an unusual burden on health systems, compromising their capacity to provide the regular care that patients with CLD require. Hence, it is incredibly crucial at this juncture to provide a set of interim recommendations on the management of patients with CLD during the current COVID-19 outbreak.


Subject(s)
Coronavirus Infections/epidemiology , Liver Diseases/epidemiology , Pneumonia, Viral/epidemiology , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Adrenal Cortex Hormones/adverse effects , Alanine/adverse effects , Alanine/analogs & derivatives , Amides/adverse effects , Antiviral Agents/therapeutic use , Azetidines/adverse effects , Betacoronavirus , Biopsy/methods , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/therapy , Comorbidity , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Drug Combinations , Drug Interactions , Enzyme Inhibitors/adverse effects , Hepatitis, Autoimmune/epidemiology , Hepatitis, Autoimmune/therapy , Hepatitis, Viral, Human/epidemiology , Hepatitis, Viral, Human/therapy , Humans , Hydroxychloroquine/adverse effects , Immunosuppressive Agents/therapeutic use , Janus Kinase Inhibitors/adverse effects , Liver Cirrhosis/epidemiology , Liver Cirrhosis/therapy , Liver Diseases/therapy , Liver Neoplasms/epidemiology , Liver Neoplasms/therapy , Liver Transplantation , Lopinavir/adverse effects , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/therapy , Pandemics/prevention & control , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Pyrazines/adverse effects , Ritonavir/adverse effects , Saudi Arabia/epidemiology , Sulfonamides/adverse effects , Ultrasonography/methods
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