Safety of disease-modifying treatments in SARS-CoV-2 antibody-positive multiple sclerosis patients

Mallucci, Giulia; Zito, Antonio; Baldanti, Fausto; Gastaldi, Matteo; Fabbro, Beatrice Dal; Franciotta, Diego; Bergamaschi, Roberto

doi:10.1016/j.msard.2021.102754

Cited by 14 publications

(13 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another study recently investigated self-reported COVID-19 symptoms and disease severity in MS patients under NTZ or fingolimod with serology confirmation for SARS-CoV-2 infection. In this study 13.4% patients on NTZ or fingolimod had anti-SARS-CoV-2 antibodies, showing no or only mild COVID-19 symptoms and, thus, supporting the hypothesis that it is safe to continue treatment with these drugs in the current setting [ 26 ].…”

Section: Discussionsupporting

confidence: 66%

Natalizumab administration in multiple sclerosis patients during active SARS-CoV-2 infection: a case series

et al. 2021

View full text Add to dashboard Cite

Background The Coronavirus disease 2019 (COVID-19) caused by the new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become a pandemic, affecting the therapeutic management for Multiple Sclerosis (MS). Any decision regarding the discontinuation of high-potency agents for moderate and highly active MS should be carefully evaluated, taking into account the potential risk of rebound of the disease. In particular, no data about clinical outcome of patients with MS receiving Natalizumab (NTZ) during active COVID-19 infection have been reported yet. Cases presentation We reported on 6 patients treated with NTZ for relapsing MS during active COVID-19 infection, who recovered without reporting any worsening or new symptoms. Most of the patients were asymptomatic, with the exception of one patient who had a slight worst COVID-19 clinical course. No patients received O2-therapy or required intensive care. No neurological complications were observed. Conclusions This paper reported the clinical outcome of patients with MS receiving NTZ during active COVID-19 infection. This case series suggests that treatment with NTZ during pandemic is relatively safe and might be continued in selected patients who are infected by COVID-19, thereby reducing the risk of MS disease rebound.

show abstract

Section: Discussionsupporting

confidence: 66%

Natalizumab administration in multiple sclerosis patients during active SARS-CoV-2 infection: a case series

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Unexpectedly, natalizumab was associated with a higher seropositivity rate in univariate analyses, although was not an independent risk factor in multivariate regression. In a small Italian study of fifty MS patients on natalizumab, the rate of seropositivity was double the local general population at 16%, but interestingly only three patients reported symptoms suggestive of a prior COVID-19 infection (32). Natalizumab is a selective adhesion molecule inhibitor that decreases specific immune cell trafficking through the blood brain barrier to the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…We anticipated a similar effect with the lymphocyte sequestering agent fingolimod, but there were only three patients on fingolimod in our cohort. Without a larger sample of post-infection or post-vaccination COVID-19 antibody data in patients on fingolimod, the impact of fingolimod in this context remains unclear ( 7 , 31 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Blunted Post-COVID-19 Humoral Immunity in Patients With CNS Demyelinating Disorders on Anti-CD20 Treatments

et al. 2022

View full text Add to dashboard Cite

With unclear characteristics of post-infection and post-vaccination immunity, the multiple sclerosis community lacks evidence to guide patients on their continued coronavirus disease 2019 (COVID-19) infection risk. As disease modifying treatments all modulate the immune system, we expect their use to alter acquired immunity to COVID-19, but the specific impact of individual treatments is unclear. To address this, we analyzed the patient and COVID-19 specific characteristics associated with post-infection humoral immunity in 58 patients with central nervous system (CNS) demyelinating disorders in the Boston metropolitan area. Univariate analysis of variance was performed using Mann Whitney U test for continuous variables, and Chi Square or Fisher Exact test for nominal variables. Univariate and stepwise multivariate nominal logistic regression identified clinical characteristics associated with COVID-19 specific nucleocapsid IgG antibody formation post-infection. Our cohort demonstrated a 42% post-infection seropositive rate with a significantly higher rate observed with shorter duration between infection and antibody collection and use of natalizumab over no/other treatment. Use of anti-CD20 treatments compared to no/other treatment was associated with a significantly lower rate of seropositivity. However, only shorter duration between infection and antibody collection as well as use of no/other treatment compared to anti-CD20 treatment were found to be independently associated with increased likelihood of post-infection seropositivity. Additionally, we demonstrate durability of antibody response up to 9 months in a small subset of patients. Thus, our data supports that patients with CNS demyelinating disorders regardless of DMT are able to form a measurable antibody response after COVID-19 infection, and that patients on anti-CD20 treatments form less robust immunity after COVID-19 infection.

show abstract

“…Several case studies have been described in the literature about the relation of SaRS-CoV-2 and fingolimod ( Mallucci et al, 2020 , Barzegar et al, Jul 2020 , Mallucci et al, 2021 , Bollo et al, 2020 ), where fingolimod was withdraw and the patients, even in the presence of low circulating lymphocytes, were able to mount an effective immune response to SARS-CoV-2. The vast majority of patients had just mild or no symptoms and patients who developed severe COVID-19 had a surprisingly rapid recovery.…”

Section: Discussionmentioning

confidence: 99%

Mild COVID-19 symptoms in a patient with multiple sclerosis in uninterrupted treatment with fingolimod

Silva¹,

MVM

2022

Neuroimmunology Reports

View full text Add to dashboard Cite

Introduction: The use of fingolimod as a long-term therapy in people with Multiple Sclerosis (PwMS) ໿is associated with a small increase in the risk of herpes virus reactivation and respiratory tract infections. At the moment, the outbreak of the novel coronavirus SARS-CoV-2 brings new challenges to physicians when deciding to continue or stop the treatment with fingolimod. Objective: We report one MS patient tested positive for SARS-CoV-2 that has not discontinued fingolimod treatment and developed only mild symptoms from COVID-19. Methods: Descriptive observational study. Discussion and conclusion: The effects of COVID-19 infection on MS patients treated with fingolimod are still uncertain. This case report outlines promising results by demonstrating a patient who didn't stop the fingolimod treatment during COVID-19 infection and developed only mild symptoms. Nevertheless, more studies are necessary to evaluate the risks and benefits of fingolimod in MS patients infected with COVID-19.

show abstract

Safety of disease-modifying treatments in SARS-CoV-2 antibody-positive multiple sclerosis patients

Cited by 14 publications

References 17 publications

Natalizumab administration in multiple sclerosis patients during active SARS-CoV-2 infection: a case series

Natalizumab administration in multiple sclerosis patients during active SARS-CoV-2 infection: a case series

Blunted Post-COVID-19 Humoral Immunity in Patients With CNS Demyelinating Disorders on Anti-CD20 Treatments

Mild COVID-19 symptoms in a patient with multiple sclerosis in uninterrupted treatment with fingolimod

Contact Info

Product

Resources

About