COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review

Dorche, Maryam Sharifian; Sahraian, Mohammad Ali; Fadda, Giulia; Osherov, Michael; Sharifian-Dorche, Amirhossein; Karaminia, Maryam; Saveriano, Alexander; Piana, Roberta La; Antel, Jack; Giacomini, Paul S.

doi:10.1016/j.msard.2021.102800

Cited by 71 publications

(96 citation statements)

References 92 publications

(253 reference statements)

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“…Second, we identified independent risk factors for COVID-19 in multivariate analysis. Similar to data from other MS registries and the general population, we confirmed higher age and BMI as independent risk factors of more severe COVID-19 (Goumenou et al, 2020;Louapre et al, 2020a;Möhn et al, 2020;Salter et al, 2021;Sharifian-Dorche et al, 2021;Sormani et al, 2021). In agreement with the COViMS (Salter et al, 2021), Musc-19 (Sormani et al, 2021) and with data in other autoimmune diseases (Gianfrancesco et al, 2020), we confirmed that high-dose glucocorticoid treatment during the 2 months before COVID-19 onset is associated with a worse disease course.…”

Section: Discussionsupporting

confidence: 90%

“…Already reported data indicates that the majority of MS patients have a mild COVID-19 course. Risk factors associated with worse clinical severity seem to be similar to that of the general population (Louapre et al, 2020a;Mares and Hartung, 2020;Möhn et al, 2020;Salter et al, 2021;Sharifian-Dorche et al, 2021;Sormani et al, 2021). However, the effect of immunomodulatory therapies on the course of COVID-19 has not been satisfactorily elucidated yet.…”

Section: Introductionmentioning

confidence: 85%

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Multiple sclerosis, neuromyelitis optica spectrum disorder and COVID-19: A pandemic year in Czechia

Stastna

Menkyová

Drahota³

et al. 2021

Multiple Sclerosis and Related Disorders

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Background: When the novel coronavirus disease 2019 (COVID-19) appeared, concerns about its course in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) arose. This study aimed to evaluate the incidence, severity and risk factors of the more severe COVID-19 course among MS and NMOSD patients. Methods: From March 1, 2020, to February 28, 2021, 12 MS centres, representing 70% of the Czech MS and NMOSD population, reported laboratory-confirmed COVID-19 cases via the Czech nationwide register of MS and NMOSD patients (ReMuS). The main outcome was COVID-19 severity assessed on an 8-point scale with a cut-off at 4 (radiologically confirmed pneumonia) according to the World Health Organisation´s (WHO) COVID-19 severity assessment. Results: We identified 958 MS and 13 NMOSD patients, 50 MS and 4 NMOSD patients had pneumonia, 3 MS and 2 NMOSD patients died. The incidence of COVID-19 among patients with MS seems to be similar to the general Czech population. A multivariate logistic regression determined that higher body mass index (BMI [OR 1.07, 95% CI, 1.00-1.14]), older age (OR per 10 years 2.01, 95% CI, 1.41-2.91), high-dose glucocorticoid treatment during the 2 months before COVID-19 onset (OR 2.83, 95% CI, 0.10-7.48) and anti-CD20 therapy (OR 7.04, 95% CI, 3.10-15.87) were independent variables associated with pneumonia in MS patients. Increase odds of pneumonia in anti-CD20 treated MS patients compared to patients with other disease-modifying therapy (same age, sex, BMI, high-dose glucocorticoid treatment during the 2 months before COVID-19 onset, presence of pulmonary comorbidity) were confirmed by propensity score matching (OR 8.90, 95% CI,). Reports on COVID-19 infection in patients with NMOSD are scarce, however, data available up to now suggest a high risk of a more severe COVID-19 course as well as a higher mortality rate among NMOSD patients. In our cohort, 4 NMOSD patients (30.77%) had the more severe COVID-19 course and 2 patients (15.39%) died.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 85%

Multiple sclerosis, neuromyelitis optica spectrum disorder and COVID-19: A pandemic year in Czechia

Stastna

Menkyová

Drahota³

et al. 2021

Multiple Sclerosis and Related Disorders

View full text Add to dashboard Cite

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“…The invasion of muscle cells, which express the ACE2 receptor, is also a possible mechanism [170,171]. On the other hand, the risk of COVID-19 infection increased with the use of immunosuppressive/immunomodulatory therapies in patients with autoimmune neuromuscular disorders [172][173][174].…”

Section: Skeletal Muscle and Neuromuscular Junction Complicationsmentioning

confidence: 99%

Neurological Complications of COVID-19: Underlying Mechanisms and Management

Shehata

Lord

Grudzinski

et al. 2021

IJMS

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COVID-19 is a severe respiratory disease caused by the newly identified human coronavirus (HCoV) Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The virus was discovered in December 2019, and in March 2020, the disease was declared a global pandemic by the World Health Organization (WHO) due to a high number of cases. Although SARS-CoV-2 primarily affects the respiratory system, several studies have reported neurological complications in COVID-19 patients. Headache, dizziness, loss of taste and smell, encephalitis, encephalopathy, and cerebrovascular diseases are the most common neurological complications that are associated with COVID-19. In addition, seizures, neuromuscular junctions’ disorders, and Guillain–Barré syndrome were reported as complications of COVID-19, as well as neurodegenerative and demyelinating disorders. However, the management of these conditions remains a challenge. In this review, we discuss the prevalence, pathogenesis, and mechanisms of these neurological sequelae that are secondary to SARS-CoV-2 infection. We aim to update neurologists and healthcare workers on the possible neurological complications associated with COVID-19 and the management of these disease conditions.

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“…Durable lymphopenia during treatment with fingolimod would be expected to induce a stronger suppression of the immune response to vaccination, and reduced titres in response to vaccination have been observed in MS patients receiving this treatment (Sharifian-Dorche et al, 2021). Nevertheless, fingolimod (or other DMTs sharing its mechanism) should not be withdrawn due to the risk of rebound MS disease (Giovannoni et al, 2017) and vaccination should proceed without interruption of treatment.…”

Section: Patients Already Receiving Treatment With a Disease-modifying Therapymentioning

confidence: 99%

Managing multiple sclerosis in the Covid19 era: a review of the literature and consensus report from a panel of experts in Saudi Arabia

Aljumah¹,

Abulaban²,

Aggad³

et al. 2021

Multiple Sclerosis and Related Disorders

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Disease-modifying therapies (DMT) for relapsing-remitting MS (RRMS) act on the immune system, suggesting a need for caution during the SARS-CoV2/Covid-19 pandemic. A group of experts in MS care from Saudi Arabia convened to consider the impact of Covid-19 on MS care in that country, and to develop consensus recommendations on the current application of DMT therapy. Covid-19 has led to disruption to the care of MS in Saudi Arabia as elsewhere. The Expert Panel considered a DMT's overall tolerability/safety profile to be the most important consideration on whether or not to prescribe at this time. Treatment can be started or continued with interferon beta, teriflunomide, dimethyl fumarate, or natalizumab, as these DMTs are not associated with increased risk of infection (there was no consensus on the initiation of other DMTs). A consensus also supported continuing treatment regimens with fingolimod (or siponimod) and cladribine tablets for a patient without active Covid-19. No DMT should be imitated in a patient with active Covid-19, and (only) interferon beta could be continued in the case of Covid-19 infection. Vaccination against Covid-19 is a therapeutic priority for people with MS. New treatment should be delayed for 2-4 weeks for vaccination. Where treatment is already ongoing, vaccination against Covid-19 should be administered immediately without disruption of treatment (first-line DMTs, natalizumab, fingolimod), when lymphocytes have recovered sufficiently (cladribine tablets, alemtuzumab) or 4 months after the last dose (ocrelizumab). These recommendations will need to be refined and updated as new clinical evidence in this area emerges.

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COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review

Cited by 71 publications

References 92 publications

Multiple sclerosis, neuromyelitis optica spectrum disorder and COVID-19: A pandemic year in Czechia

Multiple sclerosis, neuromyelitis optica spectrum disorder and COVID-19: A pandemic year in Czechia

Neurological Complications of COVID-19: Underlying Mechanisms and Management

Managing multiple sclerosis in the Covid19 era: a review of the literature and consensus report from a panel of experts in Saudi Arabia

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