Alemtuzumab in Covid era

Iovino, Aniello; Olivieri, Nunzio; Aruta, Francesco; Giaquinto, Emanuele; Ruggiero, Lucia; Spina, Emanuele; Tozza, Stefano; Manganelli, Fiore; Iodice, Rosa

doi:10.1016/j.msard.2021.102908

Cited by 11 publications

(11 citation statements)

References 29 publications

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“…None of our four patients enrolled in the survey who were under alemtuzumab developed COVID-19. Until now, there are 15 reported cases of COVID-19 with alemtuzumab ( Iovino et al., 2021 ). In a number of cases, antibody response was detected after infection ( Zabalza et al., 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Humoral response to SARS-CoV-2 COVID-19 vaccines in patients with multiple sclerosis treated with immune reconstitution therapies

Drulović¹,

Ivanovic²,

Martinović³

et al. 2021

Multiple Sclerosis and Related Disorders

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The aim of our investigation was to evaluate the humoral response to natural SARS-CoV-2 infection and to two COVID-19 vaccines (BNT162b2 Pfizer-BioNTech and Beijing/Sinopharm BBIBP-CorV) in our cohort of PwMS under high efficacy disease modifying therapies (DMTs), cladribine and alemtuzumab. Methods: Twenty two PwMS treated at the Clinic of Neurology, in Belgrade, who developed COVID-19 and/or were vaccinated against SARS-CoV-2, during treatment with cladribine and alemtuzumab, were included. Out of 18 patients treated with cladribine, 11 developed COVID-19, and 11 were vaccinated against SARS-CoV-2 (four with mRNA vaccine, 7 with Sinopharm). Four MS patients under alemtuzumab were vaccinated against SARS-CoV-2; three with mRNA, and one with Sinopharm vaccine. SARS-Cov-2 IgG response was measured using ELISA anti-spike protein-based serology (INEP, Belgrade, Serbia). Results: All 7 patients under cladribine treatment who suffered from COVID-19, developed IgG antibodies, 2.0-5.5 months after last symptoms. All four (100%) patients under cladribine who were vaccinated with Pfizer-BioNTech vaccine, and three out of seven (42.9%) vaccinated with Sinopharm, developed antibodies. All 4 patients under alemtuzumab developed antibodies after vaccination. In all cases, seroprotection occurred, irrespective of timing of vaccination and absolute lymphocyte count. Conclusion: Our findings in a small number of highly active PwMS in whom, lymphodepleting, immune reconstitution therapies, were applied in order to successfully manage MS, indicate that in a number of these patients it was possible to develop at the same time seroprotection in these patients after COVID-19 vaccination in these complex circumstances.

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Section: Discussionmentioning

confidence: 99%

Humoral response to SARS-CoV-2 COVID-19 vaccines in patients with multiple sclerosis treated with immune reconstitution therapies

Drulović¹,

Ivanovic²,

Martinović³

et al. 2021

Multiple Sclerosis and Related Disorders

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“…Patients on alemtuzumab may possibly face an increased susceptibility to SARS-CoV-2 infection and re-infection, as they are deprived of both early and late immune responses. We identified 58 alemtuzumab-treated MS patients with COVID-19 (confirmed n = 35) [ 8 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 31 , 73 , 74 , 75 , 76 , 77 , 78 ], one of them with a fatal outcome [ 25 ]. Some cases occurred shortly after the second cycle of alemtuzumab (between one week and 2-months) and the patients had moderate to severe lymphopenia (approximately 85% from lower limit of normal), despite a mild and self-limiting presentation, at no need for hospitalization.…”

Section: Resultsmentioning

confidence: 99%

Multiple Sclerosis, Disease-Modifying Therapies and COVID-19: A Systematic Review on Immune Response and Vaccination Recommendations

et al. 2021

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Understanding the risks of COVID-19 in patients with Multiple Sclerosis (MS) receiving disease-modifying therapies (DMTs) and their immune reactions is vital to analyze vaccine response dynamics. A systematic review on COVID-19 course and outcomes in patients receiving different DMTs was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Emerging data on SARS-CoV-2 vaccines was used to elaborate recommendations. Data from 4417 patients suggest that MS per se do not portend a higher risk of severe COVID-19. As for the general population, advanced age, comorbidities, and higher disability significantly impact COVID-19 outcomes. Most DMTs have a negligible influence on COVID-19 incidence and outcome, while for those causing severe lymphopenia and hypogammaglobulinemia, such as anti-CD20 therapies, there might be a tendency of increased hospitalization, worse outcomes and a higher risk of re-infection. Blunted immune responses have been reported for many DMTs, with vaccination implications. Clinical evidence does not support an increased risk of MS relapse or vaccination failure, but vaccination timing needs to be individually tailored. For cladribine and alemtuzumab, it is recommended to wait 3–6 months after the last cycle until vaccination. For the general anti-CD20 therapies, vaccination must be deferred toward the end of the cycle and the next dose administered at least 4–6 weeks after completing vaccination. Serological status after vaccination is highly encouraged. Growing clinical evidence and continuous surveillance are extremely important to continue guiding future treatment strategies and vaccination protocols.

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“…However, the use of alemtuzumab has been associated with an increased risk of infectious events, including opportunistic infections ( Giovannoni, 2018 ). Although alemtuzumab may not lead to a severe COVID-19 course ( Iovino et al, 2021 ; Matías-Guiu et al, 2020 ; Simpson-Yap et al, 2021 ; Sormani et al, 2020 ), the number of pwMS treated with alemtuzumab who have been included in COVID-19 series/registries has been deemed to be too low to draw meaningful conclusions. DMTs with a more established profile in terms of COVID-19 outcomes could be considered during COVID-19 times and temporarily delaying (between 6 and 12 months) re-dosing of alemtuzumab could be considered based on the local epidemiology of COVID-19.…”

Section: Resultsmentioning

confidence: 99%

Update on the management of multiple sclerosis during the COVID-19 pandemic and post pandemic: An international consensus statement

Reyes

Cunningham

Kalinčík

et al. 2021

Journal of Neuroimmunology

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In this consensus statement, we provide updated recommendations on multiple sclerosis (MS) management during the COVID-19 crisis and the post-pandemic period applicable to neurology services around the world. Statements/recommendations were generated based on available literature and the experience of 13 MS expert panelists using a modified Delphi approach online. The statements/recommendations give advice regarding implementation of telemedicine; use of disease-modifying therapies and management of MS relapses during the pandemic; management of people with MS at highest risk from COVID-19; management of radiological monitoring; use of remote pharmacovigilance; impact on MS research; implications for lowest income settings, and other key issues.

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Alemtuzumab in Covid era

Cited by 11 publications

References 29 publications

Humoral response to SARS-CoV-2 COVID-19 vaccines in patients with multiple sclerosis treated with immune reconstitution therapies

Humoral response to SARS-CoV-2 COVID-19 vaccines in patients with multiple sclerosis treated with immune reconstitution therapies

Multiple Sclerosis, Disease-Modifying Therapies and COVID-19: A Systematic Review on Immune Response and Vaccination Recommendations

Update on the management of multiple sclerosis during the COVID-19 pandemic and post pandemic: An international consensus statement

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