Department of Neuroscience and Rehabilitation, University of Ferrara.
Department of Neuroscience and Rehabilitation, S. Anna University Hospital, Ferrara.
Curr Opin Neurol. 2022 Jun 1;35(3):319-327. doi: 10.1097/WCO.0000000000001066.
As of January 21st 2022, over 340 million are confirmed cases of coronavirus disease 2019 (COVID-19), including nearly 5.6 million deaths. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is neurotropic and affects the neural parenchyma through direct viral invasion from the nasal mucosa and postinfectious cytokine storm. Further challenges of SARS-CoV-2 infection are nowadays linked to variants of concern. Multiple sclerosis is an inflammatory and progressive degenerative disorder of the central nervous system commonly affecting young adults and potentially generating irreversible disability. Since the beginning of the SARS-CoV-2 pandemic, people with multiple sclerosis (pwMS) have been considered 'extra' vulnerable because of the immune-mediated nature of the disease, the disability status, and the immunomodulatory therapies potentially increasing the risk for viral infection. Today multiple sclerosis neurologists are faced with several challenges in the management of pwMS to both prevent SARS-CoV-2 infection and protection from disease worsening. We aimed to highlight today's most relevant facts about the complex management of pwMS in the COVID-19 era.
The incidence of COVID-19 among pwMS does not differ from the general population. The prognosis of COVID-19 among pwMS is driven by older age, male sex, nonambulatory status, comorbidity as in the general population, as well as by corticosteroid treatment and B-cell depleting agents which decrease seropositivity from SARS-CoV-2 infection and immune responses to SARS-CoV-2 vaccination.
Disease modifying treatments (DMTs) should be regularly continued in relation to SARS-CoV-2 vaccination, but an ad hoc timing is required with B-cell depleting agents. SARS-CoV-2 vaccination is recommended in pwMS with willingness improving through health education programs. Multiple sclerosis does not seem to worsen after SARS-Cov2 vaccination but COVID-19 may enhance disease activity.
截至 2022 年 1 月 21 日，全球已确诊新冠肺炎病例超过 3.4 亿例，死亡病例近 560 万。严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）具有嗜神经性，通过从鼻腔黏膜的直接病毒入侵和感染后细胞因子风暴影响神经实质。目前，SARS-CoV-2 感染的进一步挑战与关注的变异株有关。多发性硬化症是一种中枢神经系统的炎症性和进行性退行性疾病，常见于年轻人，可能导致不可逆转的残疾。自 SARS-CoV-2 大流行开始以来，由于疾病的免疫介导性质、残疾状况以及潜在增加病毒感染风险的免疫调节治疗，多发性硬化症患者被认为是“额外”易受感染的人群。如今，多发性硬化症神经科医生在管理多发性硬化症患者时面临着几个挑战，既要预防 SARS-CoV-2 感染，又要防止疾病恶化。我们旨在强调 COVID-19 时代多发性硬化症患者复杂管理的一些最新事实。
多发性硬化症患者的 COVID-19 发病率与一般人群无差异。多发性硬化症患者 COVID-19 的预后与一般人群相同，与年龄较大、男性、非步行状态、合并症以及皮质类固醇治疗和 B 细胞耗竭剂有关，这些因素降低了 SARS-CoV-2 感染的血清阳性率和对 SARS-CoV-2 疫苗的免疫反应。
应根据 SARS-CoV-2 疫苗接种情况定期继续使用疾病修正治疗（DMT），但需要针对 B 细胞耗竭剂制定特定的时间安排。建议愿意接种疫苗的多发性硬化症患者接种 SARS-CoV-2 疫苗，通过健康教育计划提高接种意愿。多发性硬化症似乎不会在接种 SARS-Cov2 后恶化，但 COVID-19 可能会加重疾病活动。
