Yep you got it “Speed”..as well as a lot of other things. Impact factor is a metric based on how many times articles are cited. The more articles are cited in a journal the higher the impact factor
SARS-CoV-2 and Multiple Sclerosis: Not all immune depleting DMTs are equal or bad. Amor S, Baker D, Khoury SJ, Schmierer K, Giovanonni G.Ann Neurol. 2020 May 8. doi: 10.1002/ana.25770. [Epub ahead of print]
The Anals of Neurology (Impact factor 10) commentary was written and submitted after the multiple sclerosis and related disorder (Impact factor 2) paper was accepted…but it has still yet to get on pubmed.
The underpinning biology relating to multiple sclerosis disease modifying treatments during the COVID-19 pandemic. David Baker, Sandra Amor, Angray S. Kang, Klaus Schmierer, Gavin GiovannoniDOI: https://doi.org/10.1016/j.msard.2020.102174 Publication stage: In Press Journal Pre-ProofPublished online: May 11, 2020.
This looks at what was seemingly known about the mechanisms of pathology and the anti-viral immunology and asked how this related to influences of MS-DMT. This was done without any knowledge of the results in MS and suggested that maybe we should not be as worried as we were.
What do others think
COVID-19 and MS disease-modifying therapies Joseph R. Berger, Rachel Brandstadter, Amit Bar-OrMay 15, 2020
Objective To address concerns regarding the effect of MS disease-modifying therapies (DMTs) on the expression of coronavirus 2019 (COVID-19).
Methods Review of the current state of knowledge regarding the viral etiology of COVID-19, mechanisms of injury by SARS-CoV-2 infection, and the effect of individual DMTs on the risk of infection and COVID-19 disease expression.
Results Although data are limited, MS DMTs do not obviously increase the risk of acquiring symptomatic SARS-CoV-2 infection. The severe morbidity and mortality of SARS-CoV-2 appear to be largely the consequence of an overly robust immune response rather than the consequence of unchecked viral replication. The effects of specific MS DMTs on the immune response that may increase the risk of impaired viral clearance and their potential counterbalancing beneficial effects on the development of COVID-19–associated acute respiratory distress syndrome are reviewed.
Conclusion Although there is currently insufficient real-world experience to definitively answer the question of the effect of a specific MS DMT on COVID-19, registries presently in nascent form should provide these answers. This review provides an approach to addressing these concerns while the data are being accumulated. Early insights suggest that the risk of infection and associated morbidity of COVID-19 in this population is little different than that of the population at large.
The authors state The calculation regarding DMT risk in the face of COVID-19 can be distilled to the following: “risk of active disease consequent to DMT discontinuation relative to the risk of acquiring the infection and the risks of developing more aggressive COVID-19 once infection is acquired while on DMT, particularly the potentially life-threatening acute respiratory distress syndrome (ARDS) requiring ICU care and ventilatory support.
The suggestion is that interfons and natural killer cells are the important innate defence mechanism and that neutralizing antibodies block virus entry and then cytotoxic cells deal with infected cells. This however is based on Immunology 101 and has no insight from the human COVID-19 disease. A cytokine storm causes the problems. The vascular issues had yet to come on the radar.
They say “Reassuringly, initial anecdotal reports suggest that patients with MS, including those on commonly used DMTs, are at no higher risk of contracting symptomatic SARS-CoV-2 viral infection, nor at a higher risk of severe COVID-19 complications, compared with the population at large”
They suggest “In general, and in keeping with the Institute for Multiple Sclerosis Research (IMSF) report, we recommend that most patients with MS continue on their DMT” Which was rather different from the British Neurologists stance. They say “Providers will have to tailor decisions to individual patients” and say “The risks of stopping or delaying DMT must be balanced against the risk of reemergence and even rebound of MS activity after cessation”.