Neurology(R) neuroimmunology & neuroinflammation最新文献

{"title":"Aggressive Herpes Zoster in Young Patients With Multiple Sclerosis Under Dimethyl Fumarate: Significance of CD8⁺ and Natural Killer Cells.","authors":"Maria C Anagnostouli, Georgios Velonakis, Marinos C Dalakas","doi":"10.1212/NXI.0000000000001017","DOIUrl":"https://doi.org/10.1212/NXI.0000000000001017","url":null,"abstract":"Dimethyl fumarate (DMF), approved for relapsing-remitting multiple sclerosis (RRMS), exerts immune-mediated mechanisms crucial for T-cell survival and migration, preferentially reducing CD8 + T cells. 1 Although baseline absolute lymphocyte count (ALC) is considered the most critical predictor of developing lymphopenia, 2 it was recently concluded that lymphocyte subset monitoring is not required for safety vigilance because T-cell subset reduction does not increase risks for serious infections. 3 We present 2 young patients with RRMS, under DMF treatment, negative for HIV and SARS-CoV-2 (by RT-PCR in nasal swab) and with normal follow-up white blood cell (WBC)/ALC counts, who developed severe herpes zoster (HZ) infection with normal ALC but low CD8 + and high CD56 bright natural killer (NK) cells, and discuss the potential signi fi cance of T-cell immunophenotyping in HZ manifestation.","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2021-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/30/NEURIMMINFL2021038571.PMC8168045.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39028513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene-Environment Interactions in Multiple Sclerosis: A UK Biobank Study.","authors":"Benjamin Meir Jacobs, Alastair J Noyce, Jonathan Bestwick, Daniel Belete, Gavin Giovannoni, Ruth Dobson","doi":"10.1212/NXI.0000000000001007","DOIUrl":"10.1212/NXI.0000000000001007","url":null,"abstract":"<p><strong>Objective: </strong>We sought to determine whether genetic risk modifies the effect of environmental risk factors for multiple sclerosis (MS). To test this hypothesis, we tested for statistical interaction between polygenic risk scores (PRS) capturing genetic susceptibility to MS and environmental risk factors for MS in UK Biobank.</p><p><strong>Methods: </strong>People with MS were identified within UK Biobank using <i>ICD-10</i>-coded MS or self-report. Associations between environmental risk factors and MS risk were quantified with a case-control design using multivariable logistic regression. PRS were derived using the clumping-and-thresholding approach with external weights from the largest genome-wide association study of MS. Separate scores were created including major histocompatibility complex (MHC) (PRS_MHC) and excluding (PRS_non-MHC) the MHC locus. The best-performing PRS were identified in 30% of the cohort and validated in the remaining 70%. Interaction between environmental and genetic risk factors was quantified using the attributable proportion due to interaction (AP) and multiplicative interaction.</p><p><strong>Results: </strong>Data were available for 2,250 people with MS and 486,000 controls. Childhood obesity, earlier age at menarche, and smoking were associated with MS. The optimal PRS were strongly associated with MS in the validation cohort (PRS_MHC: Nagelkerke's pseudo-R² 0.033, <i>p</i> = 3.92 × 10^-111; PRS_non-MHC: Nagelkerke's pseudo-R² 0.013, <i>p</i> = 3.73 × 10^-43). There was strong evidence of interaction between polygenic risk for MS and childhood obesity (PRS_MHC: AP = 0.17, 95% CI 0.06-0.25, <i>p</i> = 0.004; PRS_non-MHC: AP = 0.17, 95% CI 0.06-0.27, <i>p</i> = 0.006).</p><p><strong>Conclusions: </strong>This study provides novel evidence for an interaction between childhood obesity and a high burden of autosomal genetic risk. These findings may have significant implications for our understanding of MS biology and inform targeted prevention strategies.</p>","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/db/NEURIMMINFL2020038026.PMC8192056.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39028512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhibition of Maternal-to-Fetal Transfer of IgG Antibodies by FcRn Blockade in a Mouse Model of Arthrogryposis Multiplex Congenita.","authors":"Ester Coutinho, Leslie Jacobson, Anthony Shock, Bryan Smith, Anthony Vernon, Angela Vincent","doi":"10.1212/NXI.0000000000001011","DOIUrl":"10.1212/NXI.0000000000001011","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether blocking the neonatal Fc receptor (FcRn) during gestation with an anti-FcRn monoclonal antibody (mAb) reduces transfer of pathogenic maternal antibodies in utero and decreases the likelihood of maternal antibody-mediated neonatal disease in the offspring.</p><p><strong>Methods: </strong>Using a previously established maternal-to-fetal transfer mouse model of arthrogryposis multiplex congenita (AMC), we assessed the effect of 4470, an anti-FcRn mAb, on the transfer of total human immunoglobulin G (IgG) and specific acetylcholine receptor (AChR)-antibodies from mother to fetus, as well as its effect on the prevention of neurodevelopmental abnormalities in the offspring.</p><p><strong>Results: </strong>Offspring of pregnant dams treated with 4470 during gestation showed a substantial reduction in total human IgG and AChR antibody levels compared with those treated with the isotype mAb control. Treatment with 4470 was also associated with a significant reduction in AMC-IgG-induced deformities (limb or spinal curve malformations) when compared with mAb control-exposed embryos and a nonsignificant increase in the percentage of fetuses showing spontaneous movements. 4470 exposure during pregnancy was not associated with changes in general parameters of maternal well-being or fetal development; indeed, male neonates showed faster weight gain and shorter time to reach developmental milestones.</p><p><strong>Conclusions: </strong>FcRn blockade is a promising therapeutic strategy to prevent the occurrence of AMC and other human maternal autoantibody-related diseases in the offspring.</p>","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/38/NEURIMMINFL2021038678.PMC8161539.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39026799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Retinal Layer Thickness With Cognition in Patients With Multiple Sclerosis.","authors":"Sharon Jean Baetge,&nbsp;Michael Dietrich,&nbsp;Melanie Filser,&nbsp;Alina Renner,&nbsp;Nathalie Stute,&nbsp;Marcia Gasis,&nbsp;Margit Weise,&nbsp;Klaudia Lepka,&nbsp;Jonas Graf,&nbsp;Norbert Goebels,&nbsp;Hans-Peter Hartung,&nbsp;Orhan Aktas,&nbsp;Sven Meuth,&nbsp;Philipp Albrecht,&nbsp;Iris-Katharina Penner","doi":"10.1212/NXI.0000000000001018","DOIUrl":"https://doi.org/10.1212/NXI.0000000000001018","url":null,"abstract":"<p><strong>Objective: </strong>Retinal layer thickness (RLT) measured by optical coherence tomography (OCT) is considered a noninvasive, cost-efficient marker of neurodegeneration in multiple sclerosis (MS). We aimed to investigate associations of RLT with cognitive performance and its potential as indicator of cognitive status in patients with MS by performing generalized estimating equation (GEE) analyses.</p><p><strong>Methods: </strong>In this cross-sectional study, patients with at least mild signs of cognitive impairment were examined by OCT as well as by the Brief International Cognitive Assessment for MS and tests assessing attention and executive functions (Trail Making Test [TMT] A and B). Associations of these factors were investigated using GEE models controlling for demographic and disease-related factors and correcting for multiple testing.</p><p><strong>Results: </strong>A total of 64 patients entered the study. In the final sample (n = 50 [n = 14 excluded due to missing data or drop-outs]; n = 44 relapsing-remitting MS and n = 6 secondary progressive MS, mean Expanded Disability Status Scale score = 2.59 [SD = 1.17], disease duration [median] = 7.34 [interquartile range = 12.1]), 36.0% were cognitively impaired. RLT of the macular retinal nerve fiber layer was associated with performance in TMT-B (β = -0.259). Analyses focusing on the upper and lower tertile of RLT additionally revealed associations between macular ganglion cell-inner plexiform layer and TMT-B and verbal short-term memory and learning, respectively.</p><p><strong>Conclusion: </strong>In patients with MS, at less advanced disease stages, RLT was especially associated with cognitive flexibility promoting OCT as a potential marker advocating further extensive neuropsychological examination.</p>","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/c6/NEURIMMINFL2020038117.PMC8161541.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39026800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Dose Pembrolizumab Treatment for Progressive Multifocal Leukoencephalopathy.","authors":"Martijn Beudel,&nbsp;Fleur Rövekamp,&nbsp;Diederik van de Beek,&nbsp;Matthijs Brouwer","doi":"10.1212/NXI.0000000000001021","DOIUrl":"https://doi.org/10.1212/NXI.0000000000001021","url":null,"abstract":"Progressive multifocal leukoencephalopathy (PML) is a rare but emerging demyelinating neurologic infection of the CNS caused by reactivation of the John Cunningham (JC) virus. Several immunocompromised populations are susceptible for PML, for example, those with hematologic malignancy, HIV infection, transplant recipients, and specific disease-modifying therapies. For the total PML population, 1and 5-year survival rates have been estimated to be 30% and 10%, respectively. Themost crucial factor in the chances of survival depends on whether immune function can be restored. Pembrolizumab is amonoclonal antibody that blocks programmed cell death protein-1 on the surface of the T cell, allowing T cells to be reactivated and to facilitate the clearance of the virus. Pembrolizumab treatment of 8 patients with PML led to decreased CSF viral load in all patients and stabilization of clinical deterioration or improvement in 5 patients. Subsequently, 2 patients with PML were reported without clinical improvement after pembrolizumab treatment. In the literature, 11 patients with PML treated with pembrolizumab have been described, of whom 6 had a favorable outcome.","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2021-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/23/NEURIMMINFL2021038766.PMC8159157.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39021614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-CD20 Depletes Meningeal B Cells but Does Not Halt the Formation of Meningeal Ectopic Lymphoid Tissue.","authors":"Rosa Margareta Brand,&nbsp;Verena Friedrich,&nbsp;Jolien Diddens,&nbsp;Monika Pfaller,&nbsp;Francesca Romana de Franchis,&nbsp;Helena Radbruch,&nbsp;Bernhard Hemmer,&nbsp;Katja Steiger,&nbsp;Klaus Lehmann-Horn","doi":"10.1212/NXI.0000000000001012","DOIUrl":"https://doi.org/10.1212/NXI.0000000000001012","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether anti-CD20 B-cell-depleting monoclonal antibodies (ɑCD20 mAbs) inhibit the formation or retention of meningeal ectopic lymphoid tissue (mELT) in a murine model of multiple sclerosis (MS).</p><p><strong>Methods: </strong>We used a spontaneous chronic experimental autoimmune encephalomyelitis (EAE) model of mice with mutant T-cell and B-cell receptors specific for myelin oligodendrocyte glycoprotein (MOG), which develop meningeal inflammatory infiltrates resembling those described in MS. ɑCD20 mAbs were administered in either a preventive or a treatment regimen. The extent and cellular composition of mELT was assessed by histology and immunohistochemistry.</p><p><strong>Results: </strong>ɑCD20 mAb, applied in a paradigm to either prevent or treat EAE, did not alter the disease course in either condition. However, ɑCD20 mAb depleted virtually all B cells from the meningeal compartment but failed to prevent the formation of mELT altogether. Because of the absence of B cells, mELT was less densely populated with immune cells and the cellular composition was changed, with increased neutrophil granulocytes.</p><p><strong>Conclusions: </strong>These results demonstrate that, in CNS autoimmune disease, meningeal inflammatory infiltrates may form and persist in the absence of B cells. Together with the finding that ɑCD20 mAb does not ameliorate spontaneous chronic EAE with mELT, our data suggest that mELT may have yet unknown capacities that are independent of B cells and contribute to CNS autoimmunity.</p>","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/cb/NEURIMMINFL2021038685.PMC8143698.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39007511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2.","authors":"","doi":"10.1212/NXI.0000000000001023","DOIUrl":"https://doi.org/10.1212/NXI.0000000000001023","url":null,"abstract":"In the article “Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2” by Sa et al., the first sentence under Results in the Abstract should read, “75 patients with PIMS-TS were identified, 9 (12%) had neurologic involvement: altered consciousness (3), behavioral changes (3), focal neurology deficits (2), persistent headaches (2), hallucinations (2), excessive sleepiness (1), and new-onset focal seizures (1).” The authors regret the error.","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143697/pdf/NXI-D-21-00006.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39007509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Disease-Modifying Therapies in Pediatric Relapsing-Remitting Multiple Sclerosis in the United Kingdom.","authors":"Omar A Abdel-Mannan, Celeste Manchoon, Thomas Rossor, Justine-Clair Southin, Carmen Tur, Wallace Brownlee, Susan Byrne, Manali Chitre, Alasdair Coles, Rob Forsyth, Rachel Kneen, Kshitij Mankad, Dipak Ram, Siobhan West, Sukhvir Wright, Evangeline Wassmer, Ming Lim, Olga Ciccarelli, Cheryl Hemingway, Yael Hacohen","doi":"10.1212/NXI.0000000000001008","DOIUrl":"10.1212/NXI.0000000000001008","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the real-world effectiveness of newer disease-modifying therapies (DMTs) vs injectables in children with relapsing-remitting multiple sclerosis (RRMS).</p><p><strong>Methods: </strong>In this retrospective, multicenter study, from the UK Childhood Inflammatory Demyelination Network, we identified children with RRMS receiving DMTs from January 2012 to December 2018. Clinical and paraclinical data were retrieved from the medical records. Annualized relapse rates (ARRs) before and on treatment, time to relapse, time to new MRI lesions, and change in Expanded Disability Status Scale (EDSS) score were calculated.</p><p><strong>Results: </strong>Of 103 children treated with DMTs, followed up for 3.8 years, relapses on treatment were recorded in 53/89 (59.5%) on injectables vs 8/54 (15%) on newer DMTs. The ARR was reduced from 1.9 to 1.1 on injectables (<i>p</i> < 0.001) vs 1.6 to 0.3 on newer DMTs (<i>p</i> = 0.002). New MRI lesions occurred in 77/89 (86.5%) of patients on injectables vs 26/54 (47%) on newer DMTs (<i>p</i> = 0.0001). Children on newer DMTs showed longer time to relapse, time to switch treatment, and time to new radiologic activity than patients on injectables (log-rank <i>p</i> < 0.01). After adjustment for potential confounders, multivariable analysis showed that injectables were associated with 12-fold increased risk of clinical relapse (adjusted hazard ratio [HR] = 12.12, 95% CI = 1.64-89.87, <i>p</i> = 0.015) and a 2-fold increased risk of new radiologic activity (adjusted HR = 2.78, 95% CI = 1.08-7.13, <i>p</i> = 0.034) compared with newer DMTs. At 2 years from treatment initiation, 38/103 (37%) patients had MRI activity in the absence of clinical relapses. The EDSS score did not change during the follow-up, and only 2 patients had cognitive impairment.</p><p><strong>Conclusion: </strong>Newer DMTs were associated with a lower risk of clinical and radiologic relapses in patients compared with injectables. Our study adds weight to the argument for an imminent shift in practice toward the use of newer, more efficacious DMTs in the first instance.</p><p><strong>Classification of evidence: </strong>This study provides Class IV evidence that newer DMTs (oral or infusions) are superior to injectables (interferon beta/glatiramer acetate) in reducing both clinical relapses and radiologic activity in children with RRMS.</p>","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39007510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Network Damage Predicts Clinical Worsening in Multiple Sclerosis: A 6.4-Year Study.","authors":"Maria A Rocca,&nbsp;Paola Valsasina,&nbsp;Alessandro Meani,&nbsp;Elisabetta Pagani,&nbsp;Claudio Cordani,&nbsp;Chiara Cervellin,&nbsp;Massimo Filippi","doi":"10.1212/NXI.0000000000001006","DOIUrl":"https://doi.org/10.1212/NXI.0000000000001006","url":null,"abstract":"<p><strong>Objective: </strong>In multiple sclerosis (MS), clinical impairment is likely due to both structural damage and abnormal brain function. We assessed the added value of integrating structural and functional network MRI measures to predict 6.4-year MS clinical disability deterioration.</p><p><strong>Methods: </strong>Baseline 3D T1-weighted and resting-state functional MRI scans were obtained from 233 patients with MS and 77 healthy controls. Patients underwent a neurologic evaluation at baseline and at 6.4-year median follow-up (interquartile range = 5.06-7.51 years). At follow-up, patients were classified as clinically stable/worsened according to disability changes. In relapsing-remitting (RR) MS, secondary progressive (SP) MS conversion was evaluated. Global brain volumetry was obtained. Furthermore, independent component analysis identified the main functional connectivity (FC) and gray matter (GM) network patterns.</p><p><strong>Results: </strong>At follow-up, 105/233 (45%) patients were clinically worsened; 26/157 (16%) patients with RRMS evolved to SPMS. The treatment-adjusted random forest model identified normalized GM and brain volumes, decreased FC between default-mode networks, increased FC of the left precentral gyrus in the sensorimotor network (SMN), and GM atrophy in the fronto-parietal network (false discovery rate [FDR]-corrected <i>p</i> = range 0.01-0.09) as predictors of clinical worsening (out-of-bag [OOB] accuracy = 0.74). An expected contribution of baseline disability was also present (FDR-p = 0.01). Baseline disability, normalized GM volume, and GM atrophy in the SMN (FDR-p = range 0.01-0.09) were independently associated with SPMS conversion (OOB accuracy = 0.84). At receiver operating characteristic analysis, including network MRI variables improved disability worsening (<i>p</i> = 0.05) and SPMS conversion (<i>p</i> = 0.02) prediction.</p><p><strong>Conclusions: </strong>Integration of MRI network measures helped determining the relative contributions of global/local GM damage and functional reorganization to clinical deterioration in MS.</p>","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/f4/NEURIMMINFL2020035055.PMC8143700.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39007508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Among Patients With Multiple Sclerosis: A Systematic Review.","authors":"Mahdi Barzegar,&nbsp;Omid Mirmosayyeb,&nbsp;Mahsa Gajarzadeh,&nbsp;Alireza Afshari-Safavi,&nbsp;Nasim Nehzat,&nbsp;Saeed Vaheb,&nbsp;Vahid Shaygannejad,&nbsp;Amir-Hadi Maghzi","doi":"10.1212/NXI.0000000000001001","DOIUrl":"https://doi.org/10.1212/NXI.0000000000001001","url":null,"abstract":"<p><strong>Objective: </strong>We systematically reviewed the literature on COVID-19 in patients with multiple sclerosis (MS).</p><p><strong>Methods: </strong>We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Google Scholar, and World Health Organization database from December 1, 2019, to December 18, 2020. Three conference abstract databases were also searched. We included any types of studies that reported characteristics of patients with MS with COVID-19.</p><p><strong>Results: </strong>From an initial 2,679 publications and 3,138 conference abstracts, 87 studies (67 published articles and 20 abstracts) consisting of 4,310 patients with suspected/confirmed COVID-19 with MS met the inclusion criteria. The female/male ratio was 2.53:1, the mean (SD) age was 44.91 (4.31) years, the mean disease duration was 12.46 (2.27), the mean Expanded Disability Status Scale score was 2.54 (0.81), the relapsing/progressive ratio was 4.75:1, and 32.9% of patients had at least 1 comorbidity. The most common symptoms were fever (68.8%), followed by cough (63.9%), fatigue/asthenia (51.2%), and shortness of breath (39.5%). In total, 837 of 4,043 patients with MS with suspected/confirmed COVID-19 (20.7%) required hospitalization, and 130 of 4,310 (3.0%) died of COVID-19. Among suspected/confirmed patients, the highest hospitalization and mortality rates were in patients with no disease-modifying therapies (42.9% and 8.4%), followed by B cell-depleting agents (29.2% and 2.5%).</p><p><strong>Conclusion: </strong>Our study suggested that MS did not significantly increase the mortality rate from COVID-19. These data should be interpreted with caution as patients with MS are more likely female and younger compared with the general population where age and male sex seem to be risk factors for worse disease outcome.</p>","PeriodicalId":520720,"journal":{"name":"Neurology(R) neuroimmunology & neuroinflammation","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/82/NEURIMMINFL2020036467.PMC8142838.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39015796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}