Réponses immunitaires au vaccin contre le virus SARS-CoV-2 et infections perthérapeutiques chez des personnes atteintes de sclérose en plaques (SEP) traitées par ocrélizumab (OCR)

Référent isabelle.lawrence@potentieldaction.com (I. Lawrence). Introduction Il a été rapporté des taux d'anticorps atténués et une réponse cellulaire T robuste après vaccination anti-SARS-CoV-2 (CoV) chez des patients atteints de SEP traités par OCR. Ces réponses immunitaires et leur lien avec la protection clinique sont mal compris. Objectifs Étudier l'effet d'OCR sur la production d'anticorps et de lymphocytes T en réponse au vaccin anti-CoV. Caractériser cliniquement les infections COVID-19 perthérapeutiques chez les personnes atteintes de SEP. Méthodes Les patients de 3 études de phase IIIb évaluant OCR, ayant souhaité recevoir un vaccin contre le SARS-CoV-2, ont participé à une évaluation exploratoire facultative. Les anticorps ont été dosés par électrochimioluminescence (Elecsys®) et les cellules T spécifiques contre 4 pools peptidiques de la protéine spike détectées par ELISpot Interferon-gamma (ImmunoSpot). Une infection perthérapeutique est définie comme une infection COVID-19 suspectée ou confirmée en laboratoire, survenant ≥ 14 jours après la primovaccination. Résultats Les échantillons de 111 patients (la plupart sous OCR ≥ 2 ans) ont été recueillis jusqu'en 09/2021. Au total, 72,1 % SEP récurrente-rémittente, 15,3 % SEP progressive-secondaire, 12,6 % SEP primaire-progressive. En moyenne (ET), 78,5 (41,4) jours séparaient la 1re dose de vaccin et la dernière perfusion d'OCR. Au total, 94/111 patients ont reçu un vaccin à ARNm, 15 un adénoviral. Une réponse à anticorps a été détectée chez 22/103 (21 %) patients et à lymphocytes T chez 83/95 (87 %). Quatre cas d'infection rapportés. Discussion Des analyses élargies (∼450 patients, jusqu'en 03/2022) seront présentées: réponses longitudinales, données après rappel vaccinal, différences entre les plateformes vaccinales, évaluation des facteurs susceptibles d'affecter les réponses immunitaires. Les corrélations entre le niveau des réponses immunitaires et le diagnostic et la sévérité de l'infection perthérapeutique seront explorées. Conclusion La proportion des personnes atteintes de SEP traitées par OCR répondant à une vaccination par la présence d'anticorps et de lymphocytes T était conforme aux données publiées.

High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing-Remitting Multiple Sclerosis.

There are > 18 distinct disease-modifying therapy (DMT) options covering 10 mechanisms of action currently approved by the US Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). Given the multitude of available treatment options, and recent international consensus guidelines offering differing recommendations, there is broad heterogeneity in how the DMTs are used in clinical practice. Choosing a DMT for newly diagnosed patients with MS is currently a topic of significant debate in MS care. Historically, an escalation approach to DMT was used for newly diagnosed patients with RRMS. However, the evidence for clinical benefits of early treatment with high-efficacy therapies (HETs) in this population is emerging. In this review, we provide an overview of the DMT options and MS treatment strategies, and discuss the clinical benefits of HETs (including ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine) in the early stages of MS, along with safety concerns associated with these DMTs. By minimizing the accumulation of neurological damage early in the disease course, early treatment with HETs may enhance long-term clinical outcomes over the lifetime of the patient.

Disease-modifying therapies (DMTs) can help people with multiple sclerosis (MS) by changing the way that their MS develops over time. Some people with MS have relapses when their symptoms get worse, followed by recovery when their MS is remitting. This is called relapsing­remitting MS (RRMS). DMTs can reduce both the number and the severity of relapses. They can also delay the nerve damage that relapses cause. A range of DMTs are approved for treating people with RRMS. These treatments work in different ways, and international treatment guidelines vary on their recommendations for using DMTs in the clinic. Selecting DMTs for people with newly diagnosed RRMS is still a topic of discussion. Previously, people with RRMS only received the more effective high-efficacy therapies (HETs) if their first treatment was not effective. HETs include ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine. Recently, using HETs at an earlier stage has shown promising results. In this review article, we provide an overview of the clinical strategies and the DMT options that are available for people with MS. Additionally, we discuss the benefits of using HETs for people with newly diagnosed MS and consider the safety issues related to DMTs. We summarize that using HETs to reduce the buildup of nerve damage during the early stages of MS may lead to improved long-term clinical outcomes over a person's lifetime.

Parents Are People Too: Implementing Empirically Based Strategies During Daily Interactions.

The outcomes of the COVID-19 pandemic have resulted in decision-making related to in-person versus remote behavior-analytic service delivery. For those service providers who shifted from delivering in-person therapy to remote consultation, parents have presumably, at least at times, assumed a role similar to a registered behavior technician (RBT). We suggest that behavior analysts recommend two empirically based strategies to parents that they could incorporate into their daily lives during service disruptions: environmental enrichment and differential reinforcement of alternative behavior. We provide examples of naturally occurring contexts during which parents could integrate these procedures: (1) self-care or daily living activities, (2) physical activity, and (3) preferred learning activities. We support selecting these strategies and their application during exemplar contexts under the premise that they do not result in additional time expenditure, afford parents opportunities to complete essential (household, work-related, or personal) tasks, and still result in therapeutic gains.

Parents Are People Too: Implementing Empirically Based Strategies During Daily Interactions

The outcomes of the COVID-19 pandemic have resulted in decision-making related to in-person versus remote behavior-analytic service delivery. For those service providers who shifted from delivering in-person therapy to remote consultation, parents have presumably, at least at times, assumed a role similar to a registered behavior technician (RBT). We suggest that behavior analysts recommend two empirically based strategies to parents that they could incorporate into their daily lives during service disruptions: environmental enrichment and differential reinforcement of alternative behavior. We provide examples of naturally occurring contexts during which parents could integrate these procedures: (1) self-care or daily living activities, (2) physical activity, and (3) preferred learning activities. We support selecting these strategies and their application during exemplar contexts under the premise that they do not result in additional time expenditure, afford parents opportunities to complete essential (household, work-related, or personal) tasks, and still result in therapeutic gains.