1
|
Zhong J, Wu Y, Zhou S, Liu C, Wen Y, Liang M, Li T, Lu T, Lv S, Gong Z, Lao D, Cao X, Tang Y, Huang W. The impact of COVID-19 on a Southern Chinese cohort with neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2024; 81:105120. [PMID: 37979411 DOI: 10.1016/j.msard.2023.105120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/07/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND There are few studies on risk factors for coronavirus disease 2019 (COVID-19) infection in patients with Neuromyelitis Optica Spectrum Disorders (NMOSD). The relationship between NMOSD relapse and COVID-19 needs to be evaluated. The objective of our study is to identify the risk factors of COVID-19 infection and NMOSD relapse among NMOSD patients with COVID-19. METHOD A total of 379 NMOSD patients registered in a NMOSD database were included in this case-control study after the end of the COVID-19 quarantine and restriction policies on December 6, 2022 in China. Data were obtained from the database. Additional information was obtained by questionnaires and the Neurology out-patient clinic. The clinical characteristics of NMOSD patients with COVID-19 were described. Risk factors associated with COVID-19 infection and outcome among patients with NMOSD were analyzed. Risk factors associated with relapse in NMOSD patients with COVID-19 were also identified. RESULTS 239 (63.1%) NMOSD patients were infected with COVID-19. Patients with NMOSD who were infected with COVID-19, in comparison to those without COVID-19, were younger at the time of interview (median [IQR] age: 43.00 [32.00-55.00] vs 49.50 [35.25-56.00] years, P = 0.029), younger at NMOSD onset (median [IQR] age: 38.00 [27.00-51.00] vs 45.00 [32.00-52.75] years, P = 0.013), had abnormal visual evoked potentials before infection (73.4% vs 54.3% P = 0.029), had lower baseline Activities of Daily Living Scale (ADL) scores (median [IQR] ADL: 14.00 [14.00-16.00] vs 14.00 [14.00-19.00], P = 0.014) or lower baseline modified Rankin Scale (mRS) scores (1.12±0.749 vs 1.33±0.991, P = 0.037), and were less frequently treated with more than 10 mg prednisone or 8 mg methylprednisolone (25.0% vs 36.0%,p = 0.026). All 9 NMOSD patients who had symptomatic cerebral syndrome developed moderate/severe COVID-19. A higher percentage of patients with moderate/severe COVID-19 experienced more than one core clinical NMOSD symptoms (61.5% vs 55.1%, p = 0.044), compared to patients with mild COVID-19. Higher risk of NMOSD relapse among NMOSD patients with COVID-19 was associated with higher Expanded Disability Status Scale (EDSS) scores (median[IQR] EDSS: 2.00 [1.00-3.00] vs 1.50 [1.00-2.25], P = 0.037) and drug treatments disruption (21.6% vs 5.0% P<0.001). CONCLUSIONS NMOSD patients with younger age, lower baseline ADL or mRS had higher incidence of being diagnosed with COVID-19 during pandemic. Glucocorticoid use may decrease the risk of COVID-19. NMOSD patients with symptomatic cerebral syndrome before the COVID-19 pandemic are associated with worse COVID-19 outcomes. Drug treatment disruption may result in relapse among NMOSD patients with COVID-19.
Collapse
Affiliation(s)
- Jian Zhong
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yu Wu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shaodan Zhou
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Chao Liu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yishuang Wen
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Manli Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Taiyan Li
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Ting Lu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Sirao Lv
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zhuowei Gong
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Dayuan Lao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Xiaoli Cao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yulan Tang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Wen Huang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
| |
Collapse
|
2
|
Spagni G, Sun B, Monte G, Sechi E, Iorio R, Evoli A, Damato V. Efficacy and safety of rituximab in myelin oligodendrocyte glycoprotein antibody-associated disorders compared with neuromyelitis optica spectrum disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2023; 94:62-69. [PMID: 36283808 DOI: 10.1136/jnnp-2022-330086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Rituximab (RTX) efficacy in patients with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorders (MOGADs) is still poorly understood, though it appears to be lower than in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders (AQP4-IgG+NMOSDs). The aim of this systematic review and meta-analysis is to assess the efficacy and safety profile of RTX in patients with MOGAD and to compare RTX efficacy between MOGAD and AQP4-IgG+NMOSD. METHODS We searched original English-language articles published between 2012 and 2021 in MEDLINE, Cochrane, Central Register of Controlled Trials and clinicaltrials.gov, reporting data on RTX efficacy in patients with MOGAD. The main outcome measures were annualised relapse rate (ARR) and Expanded Disability Status Scale (EDSS) score mean differences (MDs) after RTX. The meta-analysis was performed with a random effects model. Covariates associated with the outcome measures were analysed with a linear meta-regression. RESULTS The systematic review included 315 patients (138 women, mean onset age 26.8 years) from 32 studies. Nineteen studies (282 patients) were included in the meta-analysis. After RTX, a significant decrease of ARR was found (MD: -0.92, 95% CI -1.24 to -0.60, p<0.001), markedly different from the AQP4-IgG+NMOSD (MD: -1.73 vs MOGAD -0.92, subgroup difference testing: Q=9.09, p=0.002). However, when controlling for the mean ARR pre-RTX, this difference was not significant. After RTX, the EDSS score decreased significantly (MD: -0.84, 95% CI -1.41 to -0.26, p=0.004). The frequency of RTX-related adverse events was 18.8% (36/192) and overall RTX-related mortality 0.5% (1/192). CONCLUSIONS RTX showed effective in MOGAD, although to a lesser extent than in AQP4-IgG+NMOSD, while the safety profile warrants some caution in its prescription. Randomised-controlled trials are needed to confirm these findings and provide robust evidence to improve treatment strategies in patients with MOGAD. PROSPERO REGISTRATION NUMBER CRD42020175439.
Collapse
Affiliation(s)
- Gregorio Spagni
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy.,Neurology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy, Roma, Italy
| | - Bo Sun
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gabriele Monte
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy.,Neuroscience, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Raffaele Iorio
- Neurology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy, Roma, Italy
| | - Amelia Evoli
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy.,Neurology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy, Roma, Italy
| | - Valentina Damato
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy .,Department of Neurosciences, Drugs and Child Health, University of Florence, Firenze, Italy
| |
Collapse
|
3
|
Feige J, Berek K, Seiberl M, Hilpold P, Hitzl W, Di Pauli F, Hegen H, Deisenhammer F, Trinka E, Harrer A, Wipfler P, Moser T. Humoral Response to SARS-CoV-2 Antigen in Patients Treated with Monoclonal Anti-CD20 Antibodies: It Is Not All about B Cell Recovery. Neurol Int 2022; 14:943-951. [PMID: 36412697 PMCID: PMC9680461 DOI: 10.3390/neurolint14040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Anti-CD20 therapies decrease the humoral response to SARS-CoV-2 immunization. We aimed to determine the extent of the humoral response to SARS-CoV-2 antigens in correlation with peripheral B-cell dynamics among patients with central nervous system inflammatory disorders treated with anti-CD20 medications. We retrospectively included patients receiving anti-CD20 therapy after antigen contact who were divided into responders (>7 binding antibody units (BAU)/mL) and non-responders (<7 BAU/mL). In participants with first antigen contact prior to therapy, we investigated the recall response elicited once under treatment. We included 80 patients (responders n = 34, non-responders n = 37, recall cohort n = 9). The B-cell counts among responders were significantly higher compared to non-responders (mean 1012 cells/µL ± SD 105 vs. mean 17 cells/µL ± SD 47; p < 0.001). Despite very low B-cell counts (mean 9 cells/µL ± SD 20), humoral response was preserved among the recall cohort (mean 1653 BAU/mL ± SD 2250.1) and did not differ significantly from responders (mean 735 BAU/mL ± SD 1529.9; p = 0.14). Our data suggest that peripheral B cells are required to generate antibodies to neo-antigens but not for a recall response during anti-CD20 therapy. Evaluation of B-cell counts and pre-existing SARS-CoV-2 antibodies might serve as biomarkers for estimating the immune competence to mount a humoral response to SARS-CoV-2 antigens.
Collapse
Affiliation(s)
- Julia Feige
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Michael Seiberl
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Patrick Hilpold
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Wolfgang Hitzl
- Research Management (RM): Biostatistics and Publication of Clinical Studies Team, Paracelsus Medical University, 5020 Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, 5020 Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, 5020 Salzburg, Austria
| | - Andrea Harrer
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
- Department of Dermatology and Allergology, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Peter Wipfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +0043-57255-30300
| |
Collapse
|
4
|
Yeo T, Quek AML, Yong KP, Tye JSN, Ratnagopal P, Soon DTL, Tan K. COVID-19 infection after two doses of SARS-CoV-2 mRNA vaccine in multiple sclerosis, AQP4-antibody NMOSD and MOGAD. Mult Scler Relat Disord 2022; 65:104003. [PMID: 35803084 PMCID: PMC9233746 DOI: 10.1016/j.msard.2022.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/01/2022] [Accepted: 06/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In pre-vaccinated people with multiple sclerosis (MS), certain disease-modifying therapies (DMTs), particularly the anti-CD20 treatments, appear to be associated with an increased risk of COVID-19 infection and indeed with severe infection. It is still not known if such observations extend to vaccinated individuals and there have been considerably fewer studies in aquaporin-4-antibody neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein-antibody associated disease (MOGAD) patients. In this study, we investigated the rates of symptomatic COVID-19 infection in adult patients with MS, AQP4-NMOSD and MOGAD who had received 2 doses of SARS-CoV-2 mRNA vaccine. METHODS This was a prospective observational study conducted at the 2 main neuroimmunology referral centres in Singapore. Only patients on active follow-up were recruited to ensure robust data collection. Data on demographics, disease history, DMTs and SARS-CoV-2 mRNA vaccinations were recorded, and for those infected with COVID-19, data on COVID-19 infection was collected. RESULTS Nineteen (13 MS, 5 AQP4-NMOSD, 1 MOGAD) out of 365 (231 MS, 106 AQP4-NMOSD, 28 MOGAD) patients had COVID-19 infection despite 2 doses of SARS-CoV-2 mRNA vaccine. Amongst the infected patients, 11 patients were on DMTs (3 rituximab, 2 interferons, 1 azathioprine, 1 mycophenolate, 1 prednisolone, 1 cladribine, 1 alemtuzumab, 1 fingolimod), while 8 patients were untreated. The crude infection rate was calculated using time-at-risk analysis, revealing that rituximab had the highest infection rate amongst all the DMTs. A lower crude infection rate was observed in patients who received a third vaccination. The majority of infections were mild and no patients required oxygen supplementation. CONCLUSION Our findings suggest that patients on rituximab are still at risk of COVID-19 infection after 2 vaccinations and the receipt of a third vaccination may help to prevent infection. Future large scale studies will be required to better delineate the infection risk of different DMTs after the second and subsequent vaccinations.
Collapse
Affiliation(s)
- Tianrong Yeo
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kok Pin Yong
- Duke-NUS Medical School, Singapore, Singapore; Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Janis Siew Noi Tye
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore
| | - Pavanni Ratnagopal
- Duke-NUS Medical School, Singapore, Singapore; Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Derek Tuck Loong Soon
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
5
|
Kornek B, Leutmezer F, Rommer PS, Koblischke M, Schneider L, Haslacher H, Thalhammer R, Zimprich F, Zulehner G, Bsteh G, Dal-Bianco A, Rinner W, Zebenholzer K, Wimmer I, Steinmaurer A, Graninger M, Mayer M, Roedl K, Berger T, Winkler S, Aberle JH, Tobudic S. B Cell Depletion and SARS-CoV-2 Vaccine Responses in Neuroimmunologic Patients. Ann Neurol 2022; 91:342-352. [PMID: 35067959 PMCID: PMC9011809 DOI: 10.1002/ana.26309] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The study was undertaken to assess the impact of B cell depletion on humoral and cellular immune responses to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccination in patients with various neuroimmunologic disorders on anti-CD20 therapy. This included an analysis of the T cell vaccine response to the SARS-CoV-2 Delta variant. METHODS We investigated prospectively humoral and cellular responses to SARS-CoV-2 mRNA vaccination in 82 patients with neuroimmunologic disorders on anti-CD20 therapy and 82 age- and sex-matched healthy controls. For quantification of antibodies, the Elecsys anti-SARS-CoV-2 viral spike (S) immunoassay against the receptor-binding domain (RBD) was used. IFN-gamma enzyme-linked immunosorbent spot assays were performed to assess T cell responses against the SARS-CoV-2 Wuhan strain and the Delta variant. RESULTS SARS-CoV-2-specific antibodies were found less frequently in patients (70% [57/82]) compared with controls (82/82 [100%], p < 0.001). In patients without detectable B cells (<1 B cell/mcl), seroconversion rates and antibody levels were lower compared to nondepleted (≥1 B cell/mcl) patients (p < 0.001). B cell levels ≥1 cell/mcl were sufficient to induce seroconversion in our cohort of anti-CD20 treated patients. In contrast to the antibody response, the T-cell response against the Wuhan strain and the Delta variant was more pronounced in frequency (p < 0.05) and magnitude (p < 0.01) in B-cell depleted compared to nondepleted patients. INTERPRETATION Antibody responses to SARS-CoV-2 mRNA vaccinnation can be attained in patients on anti-CD20 therapy by the onset of B cell repopulation. In the absence of B cells, a strong T cell response is generated which may help to protect against severe coronavirus disease 2019 (COVID-19) in this high-risk population. ANN NEUROL 2022;91:342-352.
Collapse
Affiliation(s)
- Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paulus S Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Lisa Schneider
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Walter Rinner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karin Zebenholzer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Isabella Wimmer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anja Steinmaurer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Margareta Mayer
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Kilian Roedl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Judith H Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Selma Tobudic
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
COVID-19 in a Neuroimmunological Outpatient Cohort: The Bernese Experience. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic specifically affects the management and treatment of patients with autoimmune neurological disorders. Major concerns include potentially higher risks of infection or severe disease course under certain immunotherapies used to treat those disorders and the influence of COVID-19 on the underlying disease. We present data of the neuroimmunological outpatient department of the University Hospital of Bern (Switzerland). 24 cases were analyzed, 19 of them suffered from Multiple Sclerosis. Of these 24 patients, 6 were hospitalized, 2/6 were treated in the Intensive Care Unit. Possible risk factors for severe course (defined as need for hospitalization) observed in our cohort included cardiovascular risk factors, treatment with B-cell depleting agents, Sphingosine-1 Phosphate Receptor Modulators, and oral steroid therapies. These data are based on a small, retrospective observational cohort and should be interpreted with caution, although they are in line with several other cohort studies.
Collapse
|
7
|
Jovicevic V, Ivanovic J, Andabaka M, Tamas O, Veselinovic N, Momcilovic N, Mesaros S, Pekmezovic T, Drulovic J. COVID-19 and vaccination against SARS-CoV-2 in patients with neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2022; 57:103320. [PMID: 35158424 PMCID: PMC8526109 DOI: 10.1016/j.msard.2021.103320] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022]
Abstract
Background Reports on outcomes of COVID-19 in patients with neuromyelitis optica spectrum disorder (NMOSD) are scarce, as well as those related to the safety profile of the vaccines in this population. The aim of this survey is to present demographic and clinical characteristics of patients with NMOSD who developed COVID-19 and safety data of the COVID-19 vaccines in these persons. Methods This study comprise all patients from the Hospital registry of NMOSD, of the Clinic of Neurology in Belgrade, who fulfilled the 2015 NMOSD diagnostic criteria, and who after invitation by phone call, from April 10 to May 10, 2021, accepted to participate and provide information regarding COVID-19 and vaccination against Sars-CoV-2 (n = 53). Results Sixteen out of 53 enrolled NMOSD patients were diagnosed with COVID-19. In three cases (18.8%), severity of COVID-19 clinical manifestations warranted hospitalization, and one of these patients, died due to COVID-19 (case fatality ratio = 6.25%), after invasive mechanical ventilation. The remaining two patients had grade II COVID -19 severity and were hospitalized because of pneumonia, not requiring supplemental oxygen. Median EDSS in patients requiring hospitalization was 4.5, and in the non-hospitalized group, it was 3.0. Nine out of 53 patients received two doses of vaccine against Sars-Cov-2 (8 Sinopharm and one Pfizer). Pain at the site of application was the only vaccine-related adverse effect. Conclusions Our survey indicates overall favourable COVID-19 outcome and encouraging safety profile of the vaccines in persons with NMOSD, in our cohort. Prospective studies are warranted to confirm these data.
Collapse
Affiliation(s)
- Vanja Jovicevic
- Clinic of Neurology, University Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia
| | - Jovana Ivanovic
- Clinic of Neurology, University Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia
| | - Marko Andabaka
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Olivera Tamas
- Clinic of Neurology, University Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Nikola Veselinovic
- Clinic of Neurology, University Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Nikola Momcilovic
- Clinic of Neurology, University Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, University Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, 11000 Belgrade, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, University Clinical Center of Serbia, Dr Subotica 6, 11000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia.
| |
Collapse
|
8
|
Yarahmadi P, Alirezaei M, Forouzannia SM, Naser Moghadasi A. The Outcome of COVID-19 in Patients with a History of Taking Rituximab: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:411-419. [PMID: 34840381 PMCID: PMC8611224 DOI: 10.30476/ijms.2021.88717.1946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/26/2021] [Accepted: 03/13/2021] [Indexed: 01/16/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a recently emerging disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Notably, the safety of immunosuppressive medications
is a major concern during an infectious disease pandemic. Rituximab (RTX), as a monoclonal antibody against CD20 molecule, is widely used for the treatment of various diseases, mostly autoimmune
diseases and some malignancies. Previous studies indicated that RTX, as an immunosuppressive medication, may be associated with the increased risk of infections.
Moreover, given the wide use of RTX, a necessity of determining the different aspects of RTX use in the COVID-19 era is strongly felt. We reviewed current studies on the clinical
courses of patients with SARS-CoV-2 infection. It appears that the use of RTX does not increase morbidity and mortality in most patients. However, underlying diseases and other
concomitant medications may play a role in the disease course, while the concerns of vaccine efficacy in patients receiving RTX still need to be addressed.
Therefore, more controlled studies are needed for a better conclusion.
Collapse
Affiliation(s)
- Pourya Yarahmadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alirezaei
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Forouzannia
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Newsome SD, Cross AH, Fox RJ, Halper J, Kanellis P, Bebo B, Li D, Cutter GR, Rammohan KW, Salter A. COVID-19 in Patients With Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody Disease in North America: From the COViMS Registry. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1057. [PMID: 34429342 PMCID: PMC8407145 DOI: 10.1212/nxi.0000000000001057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Background and Objective To describe the impact of coronavirus disease 2019 (COVID-19) on people with neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). Methods The COVID-19 Infections in Multiple Sclerosis (MS) and Related Diseases (COViMS) Registry collected data on North American patients with MS and related diseases with laboratory-positive or highly suspected SARS-CoV-2 infection. Deidentified data were entered into a web-based registry by health care providers. Data were analyzed using t-tests, Pearson χ2 tests, or Fisher exact tests for categorical variables. Univariate logistic regression models examined effects of risk factors and COVID-19 clinical severity. Results As of June 7, 2021, 77 patients with NMOSD and 20 patients with MOGAD were reported in the COViMS Registry. Most patients with NMOSD were laboratory positive for SARS-CoV-2 and taking rituximab at the time of COVID-19 diagnosis. Most patients with NMOSD were not hospitalized (64.9% [95% CI: 53.2%–75.5%]), whereas 15.6% (95% CI: 8.3%–25.6%) were hospitalized only, 9.1% (95% CI: 3.7%–17.8%) were admitted to the ICU and/or ventilated, and 10.4% (95% CI: 4.6%–19.5%) died. In patients with NMOSD, having a comorbidity was the sole factor identified for poorer COVID-19 outcome (OR = 6.0, 95% CI: 1.79–19.98). Most patients with MOGAD were laboratory positive for SARS-CoV-2, and almost half were taking rituximab. Among patients with MOGAD, 75.0% were not hospitalized, and no deaths were recorded; no factors were different between those not hospitalized and those hospitalized, admitted to the ICU, or ventilated. Discussion Among the reported patients with NMOSD, a high mortality rate was observed, and the presence of comorbid conditions was associated with worse COVID-19 outcome. There were no deaths reported in the patients with MOGAD, although these observations are limited due to small sample size.
Collapse
Affiliation(s)
- Scott D Newsome
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL.
| | - Anne H Cross
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - Robert J Fox
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - June Halper
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - Pamela Kanellis
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - Bruce Bebo
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - David Li
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - Gary R Cutter
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - Kottil W Rammohan
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| | - Amber Salter
- From the Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; Washington University in St. Louis School of Medicine (A.H.C., A.S.), MO; Mellen Center for MS (R.J.F.), Cleveland Clinic, OH; Consortium of MS Centers (J.H.), Hackensack, NJ; MS Society of Canada (P.K.), Toronto, Ontario, Canada; National Multiple Sclerosis Society (B.B.) New York, NY; University of British Columbia (D.L.), Vancouver, British Columbia, Canada; The University of Alabama at Birmingham (G.R.C.); and University of Miami School of Medicine (K.W.R.), FL
| |
Collapse
|
10
|
Jones JM, Faruqi AJ, Sullivan JK, Calabrese C, Calabrese LH. COVID-19 Outcomes in Patients Undergoing B Cell Depletion Therapy and Those with Humoral Immunodeficiency States: A Scoping Review. Pathog Immun 2021; 6:76-103. [PMID: 34056149 PMCID: PMC8150936 DOI: 10.20411/pai.v6i1.435] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The role of humoral immunity has been well established in reducing infection risk and facilitating viral clearance in patients with COVID-19. However, the relationship between specific antibody responses and severity of COVID-19 is less well understood. METHODS To address this question and identify gaps in knowledge, we utilized the methodology of a scoping review to interrogate risk of infection and clinical outcomes of COVID-19 in patients with iatrogenic and inborn humoral immunodeficiency states based on existing literature. RESULTS Among patients with iatrogenic B-cell depletion, particularly with agents targeting CD20, our analysis found increased risk of severe COVID-19 and death across a range of underlying disease states. Among patients with humoral inborn errors of immunity with COVID-19, our synthesis found that patients with dysregulated humoral immunity, predominantly common variable immunodeficiency (CVID), may be more susceptible to severe COVID-19 than patients with humoral immunodeficiency states due to X-linked agammaglobulinemia and other miscellaneous forms of humoral immunodeficiency. There were insufficient data to appraise the risk of COVID-19 infection in both populations of patients. CONCLUSIONS Our work identifies potentially significant predictors of COVID-19 severity in patients with humoral immunodeficiency states and highlights the need for larger studies to control for clinical and biologic confounders of disease severity.
Collapse
Affiliation(s)
- Jessica M. Jones
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Aiman J. Faruqi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James K. Sullivan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Cassandra Calabrese
- Cleveland Clinic, Department of Rheumatic and Immunologic Diseases, Cleveland, Ohio
| | - Leonard H. Calabrese
- Cleveland Clinic, Department of Rheumatic and Immunologic Diseases, Cleveland, Ohio
| |
Collapse
|
11
|
Alonso R, Silva B, Garcea O, Diaz PEC, Dos Passos GR, Navarro DAR, Valle LAG, Salinas LCR, Negrotto L, Luetic G, Tkachuk VA, Míguez J, de Bedoya FHD, Goiry LG, Sánchez NER, Burgos M, Steinberg J, Balbuena ME, Alvarez PM, López PA, Ysrraelit MC, León RA, Cohen AB, Gracia F, Molina O, Casas M, Deri NH, Pappolla A, Patrucco L, Cristiano E, Tavolini D, Nadur D, Granda AMT, Weiser R, Cassará FP, Sinay V, Rodríguez CC, Lazaro LG, Menichini ML, Piedrabuena R, Escobar GO, Carrá A, Chertcoff A, Pujols BS, Vrech C, Tarulla A, Carvajal R, Mainella C, Becker J, Peeters LM, Walton C, Serena MA, Nuñez S, Rojas JI. COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America: COVID-19 in MS and NMOSD patients in LATAM. Mult Scler Relat Disord 2021; 51:102886. [PMID: 33744758 PMCID: PMC7937038 DOI: 10.1016/j.msard.2021.102886] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 12/27/2022]
Abstract
Background There is no data regarding COVID-19 in Multiple Sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients in Latin America. Objective The objective of this study was to describe the clinical characteristics and outcomes of patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with COVID-19. Methods RELACOEM is a longitudinal, strictly observational registry of MS and NMOSD patients who suffer COVID-19 and Dengue in LATAM. Inclusion criteria to the registry were either: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a COVID-19 polymerase chain reaction (PCR) test on a nasopharyngeal swab; or (2) COVID-19–typical symptoms (triad of cough, fever, and asthenia) in an epidemic zone of COVID-19. Descriptive statistics were performed on demographic and clinical variables. The cohort was later stratified for MS and NMOSD and univariate and multivariate logistic regression analysis was performed to identify variables associated with hospitalizations/intensive critical units (ICU) admission. Results 145 patients were included in the registry from 15 countries and 51 treating physicians. A total of 129 (89%) were MS patients and 16 (11%) NMOSD. 81.4% patients had confirmed COVID-19 and 18.6% were suspected cases. 23 (15.8%) patients were hospitalized, 9 (6.2%) required ICU and 5 (3.4 %) died due to COVID-19. In MS patients, greater age (OR 1.17, 95% CI 1.05 – 1.25) and disease duration (OR 1.39, 95%CI 1.14-1.69) were associated with hospitalization/ICU. In NMOSD patients, a greater age (54.3 vs. 36 years, p=<0.001), increased EDSS (5.5 vs 2.9, p=0.0012) and disease duration (18.5 vs. 10.3 years, p=0.001) were significantly associated with hospitalization/ICU. Conclusion we found that in MS patients, age and disease duration was associated with hospitalization and ICU admission requirement, while age, disease duration and EDSS was associated in NMOSD.
Collapse
Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Orlando Garcea
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | | | | | | | | | | | | | | | | | - Fernando Hamuy Diaz de Bedoya
- Departamento de Neurologia, Hospital IMT, Paraguay; Departamento de Neurologia de Diagnóstico Codas Thompson, Paraguay
| | | | | | | | | | - Maria E Balbuena
- Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Debora Nadur
- Hospital Naval - Hospital de Clínicas, Buenos Aires, Argentina
| | | | | | - Fátima Pagani Cassará
- Hospital Universitario Austral, Buenos Aires, Argentina; Fundación Favaloro, Buenos Aires, Argentina
| | | | | | - Luciana G Lazaro
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | - Raúl Piedrabuena
- Clinica Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | | | | | | | | | | | | | | | - Jefferson Becker
- Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Liesbet M Peeters
- University Multiple Sclerosis Center; Biomedical Research Institute & Data Science Institute, Hasselt University, Belgium
| | | | | | - Sebastián Nuñez
- Infectious Diseases Unit Sanatorio Güemes, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
| |
Collapse
|
12
|
Abstract
Zahlreiche neuroimmunologische Krankheitsbilder wie Enzephalopathien, Enzephalitiden, Myelitiden oder ADEM (akute disseminierte Enzephalomyelitis) sind nach einer Infektion mit SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) gehäuft aufgetreten, was für einen para- oder postinfektiösen Zusammenhang spricht. Ursächlich ist wahrscheinlich eine virusgetriggerte Überaktivierung des Immunsystems mit Hyperinflammation und Zytokin-Sturm, aber möglicherweise auch die Bildung spezifischer Autoantikörper gegen Gewebe des Zentralnervensystems, die sich vor allem im Liquor schwerkranker COVID-19(„coronavirus disease 2019“)-Patienten finden lassen. Eine direkte Schädigung durch die Invasion von SARS-CoV‑2 ins Gehirn oder Rückenmark scheint keine relevante Rolle zu spielen. Bei Patienten mit Multipler Sklerose, Myasthenie oder anderen neuroimmunologischen Krankheitsbildern wird die Anfälligkeit für eine SARS-CoV-2-Infektion sowie das Risiko eines schweren Verlaufs nicht durch die immunmodulierende Therapie bestimmt, sondern durch bekannte Risikofaktoren wie Alter, Komorbiditäten und den krankheitsbedingten Grad der Behinderung. Immuntherapien sollten bei diesen Patienten daher nicht verschoben oder pausiert werden. Inwieweit neuroimmunologische Mechanismen auch für Langzeitfolgen nach überstandener COVID-19-Erkrankung – wie Fatigue, Gedächtnis‑, Schlaf- oder Angststörungen – verantwortlich sind, werden klinische Verlaufsuntersuchungen u. a. in COVID-19-Registerstudien zeigen.
Collapse
Affiliation(s)
- Thomas Skripuletz
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nora Möhn
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christiana Franke
- Klinik für Neurologie und Experimentelle Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Harald Prüß
- Klinik für Neurologie und Experimentelle Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Berlin, Berlin, Deutschland.
| |
Collapse
|