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Gelibter S, Pirro F, Saraceno L, Susani E, Moioli MC, Puoti M, Agostoni EC, Protti A. Tixagevimab and cilgavimab use in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder during anti-CD20 treatment: A single-center experience. J Neuroimmunol 2023; 383:578199. [PMID: 37717427 DOI: 10.1016/j.jneuroim.2023.578199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND B-cell-depleting treatments, such as ocrelizumab and rituximab (anti-CD20), reduce humoral response to SARS-CoV-2 in people with Multiple Sclerosis (pwMS) and Neuromyelitis Optica Spectrum Disorder (NMOSD) and are associated with an increased risk of a more severe course of COVID-19 disease. The combination of tixagevimab and cilgavimab was authorized for COVID-19 prevention in immunocompromised subjects at high risk of severe COVID-19 disease, including patients treated with anti-CD20. Few real-world studies are available regarding the use of tixagevimab/cilgavimab in pwMS/NMOSD. In the present study, we describe the use of tixagevimab/cilgavimab for SARS-CoV-2 pre-exposure prophylaxis in a cohort of pwMS and NMOSD, treated with ocrelizumab and rituximab respectively. METHODS 26 subjects were treated with tixagevimab/cilgavimab, while we used 18 patients as the control group. We collected clinical data at baseline in all patients and during scheduled follow up evaluations. SARS-CoV-2 serological status pre- and post-tixagevimab/cilgavimab treatment was available for 10 patients. RESULTS We observed no adverse events following tixagevimab/cilgavimab treatment. Post-tixagevimab/cilgavimab anti-Spike-1-RBD IgG were significantly higher when compared to baseline values. No difference was found when comparing the percentage of COVID-19 infections between groups. All patients infected with SARS-CoV-2 had mild disease which did not require hospitalization. In patients treated with tixagevimab/cilgavimab, the rate of infection among patients exposed to SARS-CoV-2 was lower, without reaching statistical significance. We observed a significantly longer negativization time in the treated group. CONCLUSIONS Our results are not consistent with what was observed in the registration trial and some more recent studies. We did not observe a difference in COVID-19 incidence nor in disease severity in MS and NMOSD between treated and untreated patients. Our different results may be partially explained by the change in SARS-CoV-2 variants epidemiology (i.e. reduced efficacy of tixagevimab and cilgavimab against the currently dominant variants) as well as different patient selection included in the trial and different dose of tixagevimab/cilgavimab used in other studies. The present report provides a real-life experience with tixagevimab/cilgavimab in pwMS and NMOSD treated with anti-CD20, with findings that are in line with the current SARS-CoV-2 epidemiology and the recent evidence regarding SARS-CoV-2 variants. Our results warrant further research to best treat patients in the present and future pandemic scenario.
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Affiliation(s)
- Stefano Gelibter
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Fiammetta Pirro
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Saraceno
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Susani
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Cristina Moioli
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Clemente Agostoni
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Protti
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Karantzoulis A, Susani E, Ferrarese C, Appollonio I, Tremolizzo L. Coming to Terms with a Conundrum: A Case of Primary Progressive Apraxia of Speech due to Corticobasal Degeneration? Case Rep Neurol 2021; 13:483-489. [PMID: 34413751 PMCID: PMC8339446 DOI: 10.1159/000517367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Primary progressive apraxia of speech (PPAOS) is a progressive disorder impairing the motor speech act leaving linguistic function unattained. Although apraxia of speech frequently co-occurs with other neurodegenerative conditions, PPAOS defines a clinical syndrome where apraxia of speech is the sole or prominent symptom for much of the disease's natural history. Mounting evidence is beginning to fully define this disease as the epiphenomenon of 4-repeat (4R) tau pathology although other pathologic signatures have been reported. Indeed, PPAOS patients generally present a parkinsonian syndrome late into their natural history mostly qualifying for either corticobasal syndrome (CBS) or progressive supranuclear palsy (PSP). This is starting to be reflected in diagnostic criteria for PSP, namely, in the PSP speech and language (SL) subcategory; however, this inclusion is not reflected for CBS. Here, we present a single case of a patient with PPAOS and her clinical follow-up lasting 6 years, from the time she sought our attention to her death which occurred 8 years into the disease. PPAOS was the only and prominent symptom for most of the illness with extrapyramidal signs overtly presenting in the last months of its course. Clinical evaluation, imaging, genetic, and cerebrospinal fluid biomarkers all pointed toward an underlying CBD pathology, albeit the eventual anatomopathological confirmation was not performed. Had her clinical course been more suggestive of PSP, she would have qualified for criteria as PSP-SL. Our case therefore suggests the hypothetic need to discuss the broadening of the existing CBS criteria to encompass isolated PPAOS.
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Affiliation(s)
| | | | - Carlo Ferrarese
- Neurology Unit "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
| | - Ildebrando Appollonio
- Neurology Unit "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
| | - Lucio Tremolizzo
- Neurology Unit "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
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Tremolizzo L, Bianchi E, Susani E, Pupillo E, Messina P, Aliprandi A, Salmaggi A, Cosseddu M, Pilotto A, Borroni B, Padovani A, Bonomini C, Zanetti O, Appollonio I, Beghi E, Ferrarese C. Voluptuary Habits and Risk of Frontotemporal Dementia: A Case Control Retrospective Study. J Alzheimers Dis 2018; 60:335-340. [PMID: 28946566 DOI: 10.3233/jad-170260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alcohol, coffee, and tobacco consumption was assessed on 151 FTD outpatients and 151 matched controls in a multicenter retrospective case-control design. No association was found for smoking and coffee intake. The risk of FTD was decreased by alcohol consumption (adj. OR 0.30, 95% CI 0.14-0.63); risk reduction was significant in current alcohol consumers (adj. OR 0.22, 95% CI 0.10-0.51). The risk of FTD inversely correlated with the duration of exposure (adj. OR 0.88, 95% CI 0.81-0.95, for every 5 years of exposure increase). Retrospective information and the unknown amount of consumed alcohol are limits of the present work.
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Affiliation(s)
- Lucio Tremolizzo
- Neurology Unit, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Italy
| | - Elisa Bianchi
- Laboratory of Neurological Disorders, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | | | - Elisabetta Pupillo
- Laboratory of Neurological Disorders, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Paolo Messina
- Laboratory of Neurological Disorders, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | | | | | - Maura Cosseddu
- Neurology Unit, Spedali Civili and University of Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Spedali Civili and University of Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Spedali Civili and University of Brescia, Italy
| | | | - Cristina Bonomini
- Unitá Operativa Alzheimer, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Orazio Zanetti
- Unitá Operativa Alzheimer, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ildebrando Appollonio
- Neurology Unit, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Italy
| | - Ettore Beghi
- Laboratory of Neurological Disorders, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Carlo Ferrarese
- Neurology Unit, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Italy
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Tremolizzo L, Pellegrini A, Susani E, Lunetta C, Woolley SC, Ferrarese C, Appollonio I. Behavioural But Not Cognitive Impairment Is a Determinant of Caregiver Burden in Amyotrophic Lateral Sclerosis. Eur Neurol 2016; 75:191-4. [DOI: 10.1159/000445110] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/29/2016] [Indexed: 11/19/2022]
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Celani MG, Bassi MC, Bignamini A, Candelaresi P, Carlini M, Cecconi M, Congedo M, Cusi C, Cuzzubbo S, Guerra D, Macone S, Melis M, Motto C, Nardi K, Oppo V, Papetti R, Piersanti C, Piras V, Serafini A, Sgoifo AL, Susani E, Tremolizzo L, Cantisani TA. Do outcome measures used in neurological clinical research realistically represent the needs and the expectations of patients and their care givers? Trials 2015. [PMCID: PMC4460782 DOI: 10.1186/1745-6215-16-s1-p8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tremolizzo L, Susani E, Aliprandi A, Salmaggi A, Ferrarese C, Appollonio I. Muscle ultrasonography for detecting fasciculations in frontotemporal dementia. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:546-50. [DOI: 10.3109/21678421.2014.913636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lucio Tremolizzo
- Neurology Unit, San Gerardo Hospital/Monza and DCMT, University of Milano-Bicocca, Italy
| | - Emanuela Susani
- Neurology Unit, San Gerardo Hospital/Monza and DCMT, University of Milano-Bicocca, Italy
| | - Angelo Aliprandi
- Department of Neuroscience, Neurology-Stroke Unit Division, ‘A. Manzoni’ Hospital/Lecco, Italy
| | - Andrea Salmaggi
- Department of Neuroscience, Neurology-Stroke Unit Division, ‘A. Manzoni’ Hospital/Lecco, Italy
| | - Carlo Ferrarese
- Neurology Unit, San Gerardo Hospital/Monza and DCMT, University of Milano-Bicocca, Italy
| | - Ildebrando Appollonio
- Neurology Unit, San Gerardo Hospital/Monza and DCMT, University of Milano-Bicocca, Italy
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Aliberti S, Messinesi G, Gramegna A, Tremolizzo L, Susani E, Pesci A. Diaphragm ultrasonography in the management of patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:154-6. [DOI: 10.3109/21678421.2012.762931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sala G, Tremolizzo L, Melchionda L, Stefanoni G, Derosa M, Susani E, Pagani A, Perini M, Pettini P, Tavernelli F, Zarcone D, Ferrarese C. A panel of macroautophagy markers in lymphomonocytes of patients with amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2011; 13:119-24. [DOI: 10.3109/17482968.2011.611139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
OPINION STATEMENT Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of the most severe and unpredictable side effects of modern anticancer treatment. In recent years, a clear understanding of the importance of an integrated approach to CIPN has become evident, and efforts are increasing to better characterize its features and to identify more accurate methods to report and grade its occurrence. The clinically relevant impact of CIPN on cancer patients has been known for a long time, but knowledge of its pathogenetic aspects is still very limited. This incomplete knowledge is one of the major limitations in identifying targets for evidence-based neuroprotective strategies. Nevertheless, several studies have been devoted to the prevention or at least the effective treatment of symptoms secondary to peripheral nerve damage and to the early identification of patients at high risk of developing severe CIPN. Unfortunately, none of these studies has been successful and the optimal management of CIPN patients is still an unmet clinical need. Therefore, the modification of chemotherapy is currently the only available approach to limit the severity of neuropathy in the vast majority of patients. The indications for treatment modification are not universally accepted and they can differ among the various drugs. Generally, treatment modification should be considered as soon as symptoms and signs impair the daily life activities of the patient, but the possibility of a delayed worsening of CIPN after treatment withdrawal ("coasting") should always be considered, and delay of modification decisions should be avoided.
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Affiliation(s)
- Guido Cavaletti
- Department of Neuroscience and Biomedical Technology, University of Milano-Bicocca, Via Cadore 48, 20052, Monza, Italy,
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Cavaletti G, Frigeni B, Lanzani F, Mattavelli L, Susani E, Alberti P, Cortinovis D, Bidoli P. Chemotherapy-Induced Peripheral Neurotoxicity assessment: a critical revision of the currently available tools. Eur J Cancer 2010; 46:479-94. [PMID: 20045310 DOI: 10.1016/j.ejca.2009.12.008] [Citation(s) in RCA: 199] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 11/16/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
Chemotherapy-Induced Peripheral Neurotoxicity (CIPN) is a frequent, potentially severe and dose-limiting side-effect of cancer treatment. Despite its clinical relevance that limits the use of several antineoplastic agents and even the future development of new anticancer drugs, several crucial aspects of CIPN remain unsolved, one of which is how to assess its occurrence and severity in the most effective and reliable way. CIPN severity is generally assessed using Common Toxicity Criteria (CTC) scales, although it is well known that significant inter-observer disagreement exists using these scales. Moreover, most CTC scores mix impairment, disability and quality of life measures, which could lead to misinterpretation of the results and unpredictable under- or overestimation of the effect. This uncertainty may lead to different interpretations of the results of the same clinical trials by clinicians and also by regulatory agencies. The use of other types of scale based on clinical and instrumental examinations, or the use of self-administered questionnaires for patients, has not yet really improved the accuracy of CIPN assessment, although some of these tools are promising and deserve to be further validated. As a result, there is a general recognition that CIPN has still not been properly assessed and that improvements should be made. In this review, the available data regarding the different tools used to assess CIPN will be revised and their features will be critically examined, with a special focus on their reliability and reproducibility across examiners and, when available, through direct comparison.
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Affiliation(s)
- Guido Cavaletti
- Department of Neuroscience and Biomedical Technologies, University of Milan-Bicocca, Monza, Italy.
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Abstract
Analgesic concentrations of nitrous oxide were administered to 6 healthy male subjects, and blood samples were assayed for prolactin, ACTH, follicle stimulating hormone, luteinising hormone, growth hormone, cortisol and thyroid hormones. Analgesic nitrous oxide (mean concentration = 48.8%) produced statistically significant elevation of prolactin and depression of cortisol whilst not producing statistically significant changes in the other hormones assayed. The increase in prolactin and decrease in cortisol levels are similar to the hormonal changes associated with administration of opioids in man. We have also confirmed the findings of other workers that cortisol levels may not always be correlated with ACTH levels.
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Affiliation(s)
- M A Gillman
- S.A. Brain Research Institute, Johannesburg, South Africa
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