#MSCOVID19 Case reports fingolimod & CD20

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And to show balance a review from other people

COVID-19 pandemic and the risk of infection in multiple sclerosis patients on disease modifying therapies: “what the bleep do we know?” Mansoor S, Kelly S, Murphy K, Waters A, Siddiqui NS. Egypt J Neurol Psychiatr Neurosurg. 2020;56(1):44. doi: 10.1186/s41983-020-00177-0,

A conclusion is that the British Neurology Association view lacked class I evidence. In some cases it was just plain wrong. For example there have been lots of reports of CNS involvement. However it was a safety first view. They are revising this. I wonder if it they will pay any attention to the manuscript below.

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. A major concern during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is the use of immunosuppressive therapies for the treatment of multiple sclerosis (MS) due to an increased risk of contracting SARS-CoV-2 and more severe disease. The Society of Italian Neurologists (SIN) and the Association of British Neurologists (ABN) MS and Neuroimmunology Advisory Group published guidance for the use of current disease modifying treatments (DMTs) in MS (Table 1) . However, taking into account, less conservative viewpoints3 , the emerging knowledge of the biology of SARS-CoV-2, and in particular the role of the immune mechanisms contributing to the disease, we propose modification of these guidelines since it is not clear that immunosuppression is indeed detrimental in people with MS infected with SARS-CoV-2. We are thus proposing a more nuanced approach and that the categories of DMTs should be modified based on scientific principles and the biology of severe COVID-19 (Table 2).

This should be OPEN access so in the interim here is a copy in DropBox. If interested

https://www.dropbox.com/s/5sx4zovou7m7mxk/Editorial%20Annals%20of%20Neurology.pdf?dl=0

SO we are starting to see CASE REPORTS surface

Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod

Christian Foerch, Lucie Friedauer, Boris Bauer, Timo Wolf, Elisabeth H. damDOI: https://doi.org/10.1016/j.msard.2020.102180Publication stage: In Press Journal Pre-Proof

And another fingolimod case

A fine balance: Immunosuppression and immunotherapy in a patient with multiple sclerosis and COVID-19

Cristina Valencia-Sanchez, Dean M. WingerchukDOI: https://doi.org/10.1016/j.msard.2020.102182Publication stage: In Press Journal Pre-ProofPublished online: May 7, 2020.

COVID-19 infection in a patient with multiple sclerosis treated with fingolimod. Barzegar M, Mirmosayyeb O, Nehzat N, Sarrafi R, Khorvash F, Maghzi AH, Shaygannejad V.Neurol Neuroimmunol Neuroinflamm. 2020 May 5;7(4). pii: e753. 

And more on anti-CD20 in this case there were 9 people who developed COVID so 15%. Is this higher than the general population, but the risk factor seemed to be having a family member with the illness

Anti-CD20 and Covid-19 in Multiple Sclerosis and related disorders: a case series of 60 patients from Madrid, Spain

Paloma Montero-Escribano, Jorge Matías-Guiu, Patricia Gómez-Iglesias, Jesús Porta-Etessam, Vanesa Pytel, Jordi A. Matias-GuiuDOI: https://doi.org/10.1016/j.msard.2020.102185Publication stage: In Press Journal Pre-ProofPublished online: May 7, 2020

Louapre C, Maillart E, Roux T, Pourcher V, Bussone G, Lubetzki C, Papeix C. Patients with MS treated with immunosuppressive agents: Across the COVID-19 spectrum Rev Neurol (Paris). 2020 Apr 27.doi: 10.1016/j.neurol.2020.04.009 [Epub ahead of print]

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4 comments

  • Forgive my ignorance, as I’m a PwMS, not a physician. How do case reports come about, especially in this current situation? Is it entirely upon the treating physician? As a patient, do you have to consent or request that your information be shared? I know one case doesn’t equal evidence, but we keep talking about the one patient on ocrelizumab who survived and had a case report written about him but I know of one who didn’t survive here in the US, there just isn’t a case report about him (yet? I don’t know timelines either). I’m just curious how that process works. Thanks for all the information you provide!

    • Cases reports come around because the clinician believes they offer some interesting insight. I believe the clinican will need to get informed consent to report.In these cases reports as you say you have the person who survives and as you say it is known that there is someone who didn’t. There may be another case report The survival if seen as interesting because the doom and gloomers predicted a bad result. We will see a wave of these as people get their story out and then the registries will follow

      • Thank you for the information! That makes sense why there would be priority on reporting/publishing the good outcomes in this current situation to assuage fears. I hadn’t thought of it in that way.

  • “The survival if seen as interesting because the doom and gloomers predicted a bad result.”

    It would never be because some doctors, researchers have certain financial interests in protecting DMTs?

    Why do you term people who were concerned that immunosuppressive drugs may be dangerous in a pandemic of a new virus doom and gloomers? Wasn’t this an understandable concern?

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