MS Center, S Andrea Hospital, Sapienza University of Rome, Italy.
NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK; Department of Human Neuroscience, Sapienza University of Rome, Italy.
Mult Scler Relat Disord. 2020 Jun;41:102165. doi: 10.1016/j.msard.2020.102165. Epub 2020 Apr 30.
The novel Coronavirus SARS-CoV-2, which was identified after a recent outbreak in Wuhan, China, in December 2019, has generated a global pandemic impacting over 200 countries around the world. Recent reports suggest that ACE2, which is the target protein to invade the host, has a ubiquitous presence in human organs, including lung parenchyma, gastrointestinal tract, nasal mucosa, renal and urinary tract, airway epithelia, lymphoid tissues, reproductive organs, vascular endothelium and neurons. In this scenario, neurologists are particularly involved into considering even more specific therapeutic strategies according to the available data during the pandemic. In particular, MS patients are usually receiving disease-modifying therapies (DMTs) with immunosuppressant or immunomodulatory effects, which increase the risk of infections and morbidity, compared with the general population. Development of PML or other serious opportunistic infections during treatment with natalizumab forces to consider whether de-risking strategies are needed in this particular context and how to manage a high-efficacy treatment.
In this paper we report on a patient treated with natalizumab for relapsing MS who developed COVID-19 and recovered in a few days without complications.
After recovery natalizumab has been administered in the window of the extended interval dosing (EID), without reporting any worsening or new symptoms.
This case supports the opportunity to avoid discontinuing or delaying the retreatment over 8 weeks in patients recovered from a recent COVID-19.
新型冠状病毒 SARS-CoV-2 于 2019 年 12 月在中国武汉爆发后被发现，目前已在全球 200 多个国家引发了全球性大流行。最近的报告表明，作为入侵宿主的靶蛋白，ACE2 在人体器官中广泛存在，包括肺实质、胃肠道、鼻黏膜、肾脏和尿路、气道上皮、淋巴组织、生殖器官、血管内皮和神经元。在这种情况下，根据大流行期间的现有数据，神经科医生特别参与考虑更具体的治疗策略。特别是，与一般人群相比，MS 患者通常接受具有免疫抑制或免疫调节作用的疾病修正疗法 (DMT)，这会增加感染和发病的风险。在使用那他珠单抗治疗期间出现 PML 或其他严重机会性感染，这迫使我们考虑在这种特殊情况下是否需要降低风险的策略，以及如何管理高效治疗。
本文报告了一例接受那他珠单抗治疗复发性 MS 的患者，该患者感染了 COVID-19 并在几天内康复，没有出现并发症。
康复后，那他珠单抗在延长间隔给药（EID）窗口内给药，未报告任何恶化或新症状。
这例病例支持在最近 COVID-19 康复的患者中避免中断或延迟 8 周以上的再治疗的机会。
