在 COVID-19 相关封锁期间，那他珠单抗治疗的患者中约翰·坎宁安病毒血清转化率大幅降低。
Rates of John Cunningham virus seroconversion greatly reduced in natalizumab-treated patients during COVID-19-related lockdowns.
机构信息
Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
出版信息
Eur J Neurol. 2024 Jan;31(1):e16059. doi: 10.1111/ene.16059. Epub 2023 Sep 14.
BACKGROUND AND PURPOSE
This study was undertaken to retrospectively compare rates of John Cunningham virus (JCV) seroconversion in natalizumab-treated patients before and during COVID-19-related community restrictions. Natalizumab is highly effective therapy for relapsing-remitting multiple sclerosis. Prolonged exposure to natalizumab in JCV-positive patients can cause progressive multifocal leukoencephalopathy, a potentially fatal brain infection. Serial assessment of JCV status is required for patients receiving natalizumab.
METHODS
Patients receiving natalizumab at the Royal Melbourne Hospital were assessed for change in JCV serostatus and duration of exposure to natalizumab in two discrete time periods: from 1 February 2012 until 1 February 2017 ("pre-COVID"; n = 128) and from 1 April 2020 until 12 October 2022 ("COVID"; n = 214). A Poisson regression model adjusted for age at natalizumab commencement and sex was used to model seroconversion rate between the two time periods.
RESULTS
The pre-COVID JCV seroconversion rate among natalizumab-treated patients at the Royal Melbourne Hospital was 9.08%. Conversely, we found a precipitous decline in JCV seroconversion during COVID lockdown. Annualized seroconversion during COVID-19-related restrictions was 2.01%. The annualized seroconversion rate was 4.7 times higher during the pre-COVID-19 period (95% confidence interval = 2.96-7.45, p < 0.0001) compared to the annualized seroconversion rate during COVID lockdown. Males had a 2× higher rate of seroconversion compared to females.
CONCLUSIONS
JCV seroconversion among natalizumab-treated patients was markedly lower during COVID-19-related community restrictions. Restrictions observed in Melbourne were among the longest and most comprehensive implemented worldwide. This suggests the presence of modifiable risk factors that could lower rates of JCV seroconversion among natalizumab-treated patients.
背景与目的
本研究旨在回顾性比较 COVID-19 相关社区限制前后，那他珠单抗治疗患者中约翰·坎宁安病毒（JCV）血清转化的发生率。那他珠单抗是治疗复发缓解型多发性硬化症的高效疗法。JCV 阳性患者长期暴露于那他珠单抗可导致进行性多灶性白质脑病，这是一种潜在致命的脑部感染。接受那他珠单抗治疗的患者需要定期评估 JCV 状态。
方法
在墨尔本皇家医院接受那他珠单抗治疗的患者，评估了其 JCV 血清学状态的变化以及暴露于那他珠单抗的时间长短，分为两个不同的时间段：2012 年 2 月 1 日至 2017 年 2 月 1 日（“COVID-19 前”；n=128）和 2020 年 4 月 1 日至 2022 年 10 月 12 日（“COVID-19 期间”；n=214）。使用泊松回归模型，根据那他珠单抗开始使用时的年龄和性别进行调整，以模拟两个时间段之间的血清转化率。
结果
在墨尔本皇家医院接受那他珠单抗治疗的患者中，COVID-19 前 JCV 血清转化率为 9.08%。相反，我们发现 COVID 封锁期间 JCV 血清转化率急剧下降。COVID-19 相关限制期间的年化血清转化率为 2.01%。与 COVID-19 前相比，COVID-19 期间的年化血清转化率高出 4.7 倍（95%置信区间为 2.96-7.45，p<0.0001）。与女性相比，男性的血清转化率高 2 倍。
结论
COVID-19 相关社区限制期间，那他珠单抗治疗患者的 JCV 血清转化率明显降低。墨尔本实施的限制措施是全球最长和最全面的限制措施之一。这表明存在可改变的危险因素，可能会降低那他珠单抗治疗患者的 JCV 血清转化率。
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