COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review
| Autor: | Paul S. Giacomini, Maryam Sharifian-Dorche, Jack P. Antel, Giulia Fadda, Michael Osherov, Amirhossein Sharifian-Dorche, Mohammad Ali Sahraian, Roberta La Piana, Alexander Saveriano, Maryam Karaminia |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Central Nervous System
medicine.medical_specialty Clinical Neurology Disease Review Article Multiple sclerosis 03 medical and health sciences 0302 clinical medicine Internal medicine Pandemic medicine Humans Immunologic Factors Disease-modifying therapies 030212 general & internal medicine Expanded Disability Status Scale Neuromyelitis optica business.industry SARS-CoV-2 Mortality rate COVID-19 General Medicine medicine.disease Fingolimod Neuromyelitis optica spectrum disorder Neurology Rituximab Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Multiple Sclerosis and Related Disorders |
| ISSN: | 2211-0348 |
| DOI: | 10.1016/j.msard.2021.102800 |
| Popis: | Introduction The Coronavirus disease-19 (COVID-19) pandemic continues to expand across the world. This pandemic has had a significant impact on patients with chronic diseases. Among patients with demyelinating diseases of the central nervous system (CNS), such as Multiple Sclerosis (MS) or Neuromyelitis Optica Spectrum Disorder (NMOSD), concerns remain about the potential impact of COVID-19 on these patients given their treatment with immunosuppressive or immunomodulatory therapies. In this study, we review the existing literature investigating the impact of disease-modifying therapies(DMT) on COVID-19 risks in this group of patients. Method For this systematic review, we searched PubMed from January 1, 2020, to December 3, 2020. The following keywords were used: “COVID-19” AND “Multiple Sclerosis” OR “Neuromyelitis Optica.” Articles evaluating COVID-19 in patients with demyelinating diseases of CNS were included. This study evaluates the different aspects of the DMTs in these patients during the COVID-19 era. Results and conclusion A total of 262 articles were found. After eliminating duplicates and unrelated research papers, a total of 84 articles met the final inclusion criteria in our study. Overall, the experiences of 2493 MS patients and 37 NMOSD patients with COVID-19 were included in this review. Among them, 46(1.8%) MS patients died(the global death-to-case ratio of Covid-19 was reported about 2.1%). Among DMTs, Rituximab had the highest mortality rate (4%). Despite controversies, especially concerning anti-CD20 monoclonal antibody therapies, a relation between DMT-use and COVID-19 disease- course was not found in many studies. This observation reinforces the recommendation of not stopping current DMTs. Other variables such as age, higher expanded disability status scale (EDSS) scores, cardiac comorbidities, and obesity were independent risk factors for severe COVID-19. Despite the risks of infection, most patients were willing to continue their DMT during the pandemic because of more significant concern about the risk of relapse or worsening MS symptoms. After the infection, an immune response's attenuation was seen in the patients on Fingolimod and anti-CD20 monoclonal antibodies. This may be a critical finding in future vaccinations. |
| Databáze: | OpenAIRE |
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