RESUMO
Introduction: There are no reports in LATAM related to longitudinal humoral and cellular response to adenovirus based COVID-19 vaccines in people with Multiple Sclerosis (pwMS) under different disease modifying therapies (DMTs) and neutralization of the Omicron and Wuhan variants of SARS-COV-2. Methods: IgG anti- SARS-COV-2 spike titer were measured in a cohort of 101 pwMS under fingolimod, dimethyl fumarate, cladribine and antiCD20, as well as 28 healthy controls (HC) were measured 6 weeks after vaccination with 2nd dose (Sputnik V or AZD1222) and 3nd dose (homologous or heterologous schedule). Neutralizing capacity was against Omicron (BA.1) and Wuhan (D614G) variants and pseudotyped particles and Cellular response were analyzed. Results: Multivariate regression analysis showed anti-cd20 (ß= -,349, 95% CI: -3655.6 - -369.01, p=0.017) and fingolimod (ß=-,399, 95% CI: -3363.8 - -250.9, p=0.023) treatments as an independent factor associated with low antibody response (r2 adjusted=0.157). After the 2nd dose we found a correlation between total and neutralizing titers against D614G (rho=0.6; p<0.001; slope 0.8, 95%CI:0.4-1.3), with no differences between DMTs. Neutralization capacity was lower for BA.1 (slope 0.3, 95%CI:0.1-0.4). After the 3rd dose, neutralization of BA.1 improved (slope: 0.9 95%CI:0.6-1.2), without differences between DMTs. A fraction of pwMS generated anti-Spike CD4+ and CD8+ T cell response. In contrast, pwMS under antiCD20 generated CD8+TNF+IL2+ response without differences with HC, even in the absence of humoral response. The 3rd dose significantly increased the neutralization against the Omicron, as observed in the immunocompetent population. Discussion: Findings regarding humoral and cellular response are consistent with previous reports.
Assuntos
Anticorpos Neutralizantes , Anticorpos Antivirais , Vacinas contra COVID-19 , COVID-19 , Imunossupressores , Esclerose Múltipla , SARS-CoV-2 , Humanos , Masculino , Feminino , Imunossupressores/uso terapêutico , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , SARS-CoV-2/imunologia , Pessoa de Meia-Idade , Esclerose Múltipla/imunologia , Esclerose Múltipla/tratamento farmacológico , COVID-19/imunologia , COVID-19/prevenção & controle , Adulto , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Anticorpos Neutralizantes/imunologia , Anticorpos Neutralizantes/sangue , Argentina , Adenoviridae/genética , Adenoviridae/imunologia , Imunidade Humoral , Glicoproteína da Espícula de Coronavírus/imunologiaRESUMO
BACKGROUND: Tobacco smoking is an important, modifiable, environmental risk factor for multiple sclerosis (MS) with a relevant impact on health-related quality of life (HRQOL). We aimed to assess the use of tobacco in individuals with MS from Latin America (LATAM), and its impact on HRQOL. METHODS: We conducted a cross-sectional study based on a LATAM web-based survey. Demographics, social and clinical data, information on physical disability, and HRQOL scores were collected using the MS Impact Scale-29 (MSIS-29), the Fatigue Severity Scale (FSS), and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Individuals with MS were classified at the time of the survey as follows: never-smokers (ie, patients who reported they had never smoked), past smokers (those who had smoked tobacco but not during the past year), or current smokers. For the analysis, groups were compared. RESULTS: 425 patients (74.6% female) from 17 LATAM countries were included, mean age 43.6 ± 11 years and median Expanded Disability Status Scale score 2. There were 122 (28.7%) current smokers, 178 (41.9%) past smokers, and 125 (30.4%) never-smokers. Current smokers had significantly higher MSIS-29 physical (physical worsening), FSS (fatigue), and HADS-A (anxiety) scores compared with past and never-smokers after being adjusted for covariables. No significant differences were observed in any of the other analyzed demographic, clinical, and therapeutic variables. Thirty percent of the current and past smokers groups had never had their neurologists discuss smoking cessation with them. CONCLUSIONS: Individuals with MS who were current smokers had higher fatigue and anxiety scores and worse HRQOL compared with past and never-smokers.
RESUMO
BACKGROUND: To date, there are no data available on the safety of COVID-19 vaccines in Latin American patients with Multiple Sclerosis (MS). OBJECTIVE: Characterize safety of COVID-19 vaccines in Latin American (LATAM) patients with Multiple Sclerosis (pwMS). METHODS: A cross-sectional study between February 1, 2021, and April 30, 2021. Individuals with MS from LATAM countries were invited to participate in a self-administered web-based survey, through MS patient organizations from the region. RESULTS: 393 vaccinated pwMS from 10 different Latin American countries were included. The vaccines administered were: inactivated virus vaccines (IVV) in 38.2% of patients, adenovirus vector vaccines (AdV) in 48.8% and mRNA vaccines 13%. All patients received at least one dose of any of the COVID-19 vaccines and 123 (31.3%) declared receiving a second dose. Mean (SD) age 41.5 (11.8) years, 82.4% female, MS disease duration: 8.4 (8.2) years. No serious adverse events were reported with any of the COVID-19 vaccines after either the first or second dose. A lower frequency of adverse events was found with IVV (22%) in comparison with AdV (46.4%) and mRNA (35.3%) (p < 0.01). Five participants reported having an MS relapse after IVV first dose. CONCLUSION: COVID-19 vaccines applied in LATAM proved safe for MS patients.
RESUMO
The objective of the present study was to identify the frequency of MS patients in Latin America (LATAM) that received the influenza vaccine during the most recent season and the reasons related to non-vaccination. Cross-sectional study between November and December 2020 in a large cohort of MS patients from LATAM. Patients responded about recommendation of receiving influenza vaccine and the use of it as well as reasons for not using the vaccine. Four hundred twelve MS patients were included in the analysis. 47.3% of patients were recommended to receive the vaccine from the treating physician. Nearly 54% of patients did not receive the influenza vaccine, and the most frequent cause was that it was neither recommended nor mentioned by the treating physician (27.4%). Female gender (OR = 2.3, 95%CI 1.4-3.8, p = 0.001) was associated with an increased risk of recommendation, while a progressive form of MS and higher EDSS decreased the risk (OR = 0.49, 95%CI 0.27-0.90, p = 0.023; OR = 0.65, 95%CI 0.55-0.97, p = 0.02, respectively). Despite the evidence to recommend the influenza vaccine in MS patients, a limited number of patients in clinical practice received such recommendation.
Assuntos
Influenza Humana , Esclerose Múltipla , Estudos Transversais , Feminino , Humanos , Influenza Humana/prevenção & controle , América Latina , Esclerose Múltipla/tratamento farmacológico , VacinaçãoRESUMO
As human and economic resources are limited, especially in Latin America (LATAM), it is important to identify research priorities to improve multiple sclerosis (MS) patients care in the region. The objective was to generate a multidisciplinary consensus on research priorities in MS for patients care in LATAM by involving healthcare professionals and MS patient associations. METHODS: consensus was reached through a four-step modified Delphi method designed to identify and rate research priorities in MS in LATAM. The process consisted of two qualitative assessments, a general ranking phase and a consensus meeting followed by a more detailed ranking phase RESULTS: a total of 62 participants (35 neurologists, 4 nurses, 12 kinesiologists, 7 neuropsychologists and 4 patient association members) developed the process. At the final ranking stage following the consensus meeting, each participant provided their final rankings, and the top priority research questions were outlined. 11 research priorities were identified focusing on healthcare access, costs of the disease, physical and cognitive evaluation and rehabilitation, quality of life, symptoms management, prognostic factors, the need of MS care units and patient's management in emergencies like COVID-19. CONCLUSION: this work establishes MS research priorities in LATAM from multiple perspectives. To pursue the actions suggested could launch the drive to obtain information that will help us to better understand the disease in our region and, especially, to better care for affected patients.
Assuntos
COVID-19 , Esclerose Múltipla , Humanos , América Latina/epidemiologia , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/terapia , Qualidade de Vida , Pesquisa , SARS-CoV-2RESUMO
BACKGROUND: Multiple sclerosis (MS), is an emergent disease in Latin America (LATAM), which raises substantial socioeconomic challenges to a region where most countries remain as economies in development. OBJECTIVE: To assess barriers to access and utilization of MS care services in a regional cohort survey. METHODS: We conducted a cross-sectional study based on a self-reported survey. Patients with MS (PwMS) completed this regional survey in 12 Latin American (LATAM) countries. PwMS were also divided into those with healthcare insurance (including certain local national social security programs) and those without healthcare insurance (treated at public institutions). RESULTS: We surveyed 1469 PwMS and identified significant regional differences in relation to access to complementary tests, rehabilitation services, and prescription of disease-modifying therapies (DMTs). Between 44.4% and 73.5% of PwMS were unemployed and nearly 50% had completed higher education. PwMS receiving care from the private sector reported greater access to imaging, DMTs, and fewer problems obtaining DMTs compared to those treated at public institutions. Multivariate analysis showed that lack of private insurance (OR = 2.21, p < 0.001), longer MS duration (OR = 1.02, p = 0.001), lower level of education (OR = 0.66, p = 0.009), and unemployment (OR = 0.73, p = 0.03) were independently associated with inappropriate delivery of DMTs. CONCLUSION: These findings suggest barriers to access and utilization of MS care services across LATAM are prevalent. We identified several factors predicting unmet healthcare needs in PwMS.
Assuntos
Esclerose Múltipla , Estudos de Coortes , Estudos Transversais , Humanos , América Latina/epidemiologia , Esclerose Múltipla/terapia , Inquéritos e QuestionáriosRESUMO
The objective was to evaluate the interval from first symptom of multiple sclerosis (MS) to diagnosis with the introduction of MS diagnostic criteria in a Latin American (LATAM) population. METHODS: Patients with relapsing-remitting MS (RRMS) completed a survey in 12 LATAM countries. Date of disease onset (first relapse) and date of diagnosis (confirmed disease) were required. Survival probabilities were evaluated for 5 diagnosis epoch groups: group 1: 1983-2000 Poser; group 2: 2001-2004 McDonald's first version; group 3: 2005-2009 revisions of 2005; group 4: 2010-2016 revisions of 2010; and group 5: 2017-2019 revisions of 2017. RESULTS: 1188 (75.6% females) patients were included. Mean time from disease onset to diagnosis in group 1 was 21 ± 8 months; in group 2, 19 ± 7 months; in group 3, 16 ± 10 months; in group 4, 9.6 ± 8.5 months; and in group 5, 8.2 ± 10 months. Significant differences were observed between groups 1, 2, 3 vs. 4 and 5 (p<0.001), while no differences were observed between groups 4 and 5 (p=0.08). CONCLUSION: We observed a significant shortening of time from MS onset to diagnosis with the adoption of new diagnostic criteria in LATAM.