#MSCOVID19. Time for business?

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COVID-19 and high-efficacy multiple sclerosis therapies: Time for business as usual?Brownlee WJ.Mult Scler. 2020 Aug 7:1352458520948211. doi: 10.1177/1352458520948211.

“In the vast majority of people with MS, COVID-19 produces a mild illness. Preliminary data suggest that older age, comorbidities and more advanced physical disability are more strongly associated with poor outcomes in people with MS with COVID-19 than disease-modifying therapy use. With falling rates of new COVID-19 infections in most countries, and reassuring reports of mild COVID-19 infection even in our most immunosuppressed patients, are we now ready for business as usual when treating MS?” “The answer is probably yes, and in many otherwise healthy, young adults with MS, the risks of disability worsening from delayed initiation or re-treatment with a high-efficacy treatment (or opting for a less effective treatment) will outweigh the potential risks of severe COVID-19 infection”.

Business as usual, but the ABN I heard was not sitting again so can business be normal whilst the treatment guidelines are they way tehy are? So maybe time to modify recommendations, so business can return to normal.

CD20-depletion blunts the cOVID-specific antibody response

Recovery from COVID-19 in a B-cell-depleted multiple sclerosis patient. Wurm H, Attfield K, Iversen AK, Gold R, Fugger L, Haghikia A.Mult Scler. 2020 Aug 7:1352458520943791. Here, we report on an MS patient who had received rituximab for ~3 years. The patient was examined 5 days before the onset of coronavirus disease 2019 (COVID-19) symptoms and was admitted to the hospital 2 days after. She recovered 14 days after symptom onset despite having a 0% B lymphocyte count and not developing SARS-CoV-2 immunoglobulin G (IgG) antibodies. Oxford University have been all over COVID and this is the first associated paper. The paper was received: May 25, 2020; Revisions received: June 19, 2020; Accepted: June 22, 2020…but we know this already….Thornton JR, Harel A. Negative SARS-CoV-2 antibody testing following COVID-19 infection in Two MS patients treated with ocrelizumab [published online ahead of print, 2020 Jun 26]. Mult Scler Relat Disord. 2020;44:102341. doi:10.1016/j.msard.2020.102341. Received 23 June 2020; Accepted 25 June 2020.

So the speed of the refereeing made the difference to who got their first. But they weren’t first,

We already knew it.

Lucchini M, Bianco A, Del Giacomo P, De Fino C, Nociti V, Mirabella M. Is serological response to SARS-CoV-2 preserved in MS patients on ocrelizumab treatment? A case report [published online ahead of print, 2020 Jun 22]. Mult Scler Relat Disord. 2020;44:102323. Received 28 May 2020; Received in revised form 9 June 2020; Accepted 21 June 2020. Meca-Lallana V, Aguirre C, Beatrizdel Río, Cardeñoso L, Alarcon T, Vivancos J. COVID-19 in 7 multiple sclerosis patients in treatment with ANTI-CD20 therapies [published online ahead of print, 2020 Jun 15]. Mult Scler Relat Disord. 2020;44:102306. doi:10.1016/j.msard.2020.102306. Received 2 May 2020; Received in revised form 6 June 2020; Accepted 13 June 2020.

We don’t need to hear about any more ocrelizumab case reports unless they say something we don’t know. I think we have had case reports about most MS drugs but I havent done one on Cladribine yet. So he goes.

COVID-19 pneumonia in a multiple sclerosis patient with severe lymphopenia due to recent cladribine treatment.Dersch R, Wehrum T, Fähndrich S, Engelhardt M, Rauer S, Berger B.Mult Scler. 2020 Aug 7:1352458520943783. doi: 10.1177/1352458520943783.Received: May 17, 2020; Revisions received: June 18, 2020; Accepted: June 22, 2020. Background: Most cases of COVID-19 are considered mild, but patients with immunosuppressant treatment might be prone to severe courses of disease. Expert panels advise to delay treatment with cell-depleting MS therapies during the COVID-19 pandemic. Methods: We report a case of a patient with relapsing-remitting multiple sclerosis who developed COVID-19 pneumonia 2 weeks after the first week of cladribine therapy.Results: Despite a severe lymphopenia (absolute lymphocyte count 240/µL), the patient had a moderate course of COVID-19.Conclusion: Apart from maximal supportive treatment, this could be due to cladribine reducing inflammatory response, which probably contributes considerably to severe courses of COVID-19 pneumonia.”Fourteen days after the first week of cladribine therapy, the patient developed fever and malaise. SARS-CoV-2 was tested as the symptoms of the patient developed during the COVID-19 pandemic. An oropharyngeal swab was positive for SARS-CoV-2-RNA. At this time, the patient showed CTC grade 3 lymphopenia (ALC = 240/µL). However, since his symptoms were rather mild, hospital admission at that time was not necessary”.”However, due to persistent fever (39.5°C) and progressive respiratory symptoms with thoracic pain, hospitalization occured. The person with MS was about 60 nd male. They recieved oxygen. A repeated oropharyngeal swab 28 days after onset of the infection was still positive for SARS-CoV-2-RNA. The patient was discharged after 16 days because respiratory symptoms and fever had ceased and inflammatory markers had declined. During COVID-19 pneumonia, neurological symptoms remained stable”.”In summary, the first case report of an MS patient developing COVID-19 infection with severe lymphopenia while under immunosuppressive therapy with cladribine is reassuring because the patient did not develop a fatal disease course and recovered without any sequelae”

Not exactly the first and as you can see not all people are hospitalised

Louapre C, Collongues N, Stankoff B, et al. Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis [published online ahead of print, 2020 Jun 26]. JAMA Neurol. 2020;e202581. doi:10.1001/jamaneurol.2020.2581

Sormani MP; Italian Study Group on COVID-19 infection in multiple sclerosis. An Italian programme for COVID-19 infection in multiple sclerosis [published correction appears in Lancet Neurol. 2020 May 28;:]. Lancet Neurol. 2020;19(6):481-482. doi:10.1016/S1474-4422(20)30147-2

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MouseDoctor

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  • Business as usual indeed – basically no treatment then for most PPMS sufferers in the UK! The same as before COVID-19! Brilliant!

  • Yes, well now there’s this paper written about 7 patients that all did well on anti cd20 therapy, but what about those that have been on long term therapy with depleted CD4 and CD8 T cells as well? How will they fair? And is it ok for these people to return to high risk frontline professions?

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