COVID-19 in a multiple sclerosis (MS) patient treated with alemtuzumab: Insight to the immune response after COVID

Abstract

Background The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is a novel disease that has spread abruptly over the world, allowing the development of countermeasures an urgent global priority. It has been speculated that elder people and patient with comorbidities may be at risk of developing complication. On the other hand, it has been seen that immunosuppressed patients could develop a mild presentation of the disease. Based on this hypothesis, several immunosuppressant agents are currently being tested as potential treatment for coronavirus 2019 (COVID-19). Methods report a patient treated with alemtuzumab (Humanized monoclonal antibody against the lymphocyte and monocyte surface antigen CD52, which depletes B and T cells) ( Thompson et al., 2018 ) for recurrent remittent multiple sclerosis (RRMS) who developed mild COVID-19. Results Despite complete B and T cell depletion, patient symptoms abated few days with no need for hospitalization due to COVID-19 and no clinical evidence of disease activation regarding her MS. Discussion This report shows that MS patients with mild depletion of B and T cells can mount an antiviral response against COVID-19 and produce IgG.

COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review

“…Overall, the data of 2493 MS patients and 37 NMOSD patients were reported with COVID-19. ( Table 1 , 2 ) ( Sahraian et al, 2020 , Safavi et al, 2020 , Bowen et al, 2020 , Louapre et al, 2020 , Dalla Costa et al, 2020 , Parrotta et al, 2020 , Barzegar et al, 2020 , Ciampi et al, 2020 , Mantero et al, 2020 , Sahraian et al, 2020 , Nesbitt et al, 2020 , Chaudhry et al, 2020 , Castillo Álvarez et al, 2020 , Shalhoub, 2020 , Delbue et al, 2007 , Berger and Brandstadter, 2020 , Maillart et al, 2020 , Ciampi et al, 2020 , Mantero et al, 2020 , Crescenzo et al, 2020 , Mehta et al, 2019 , Maghzi et al, 2020 , Möhn et al, 2020 , Bollo et al, 2020 , Ciardi et al, 2020 , Valencia-Sanchez and Wingerchuk, 2020 , Foerch et al, 2020 , Barzegar et al, 2020 , Chiarini et al, 2020 , Gomez-Mayordomo et al, 2020 , Mallucci et al, 2020 , Giovannoni et al, 2020 , Borriello and Ianniello, 2020 , Louapre et al, 2020 , Aguirre et al, 2020 , Rimmer et al, 2020 , Luna et al, 2019 , Carandini et al, 2020 , Matías-Guiu et al, 2020 , Guevara et al, 2020 , Fernández-Díaz et al, 2020 , Amor et al, 2020 , Fiorella and Lorna, 2020 , Dersch et al, 2020 , De Angelis et al, 2020 , Celius, 2020 , Jack et al, 2020 , Suwanwongse and Shabarek, 2020 , Ghajarzadeh et al, 2020 , Montero-Escribano et al, 2020 , Novi et al, 2020 , …”

“…( Rimmer et al, 2020 ) 3-52 -year-old Female, RRMS,EDSS:5, no Comorbidity . ( Sormani et al, 2020 ) 136 233 3(1.2%) Alemtuzumab ( Louapre et al, 2020 , Ciampi et al, 2020 , Nesbitt et al, 2020 , Chaudhry et al, 2020 , Castillo Álvarez et al, 2020 , Carandini et al, 2020 , Matías-Guiu et al, 2020 , Guevara et al, 2020 , Fernández-Díaz et al, 2020 , Fiorella and Lorna, 2020 , Sormani et al, 2020 , Evangelou et al, 2020 , Loonstra et al, 2020 ) 14 23 37 0 Alemtuzumab/ Cladribine ( Dalla Costa et al, 2020 ) 15 15 0 Cladribine ( Louapre et al, 2020 , Nesbitt et al, 2020 , Castillo Álvarez et al, 2020 , Dersch et al, 2020 , De Angelis et al, 2020 , Celius, 2020 , Jack et al, 2020 , Sormani et al, 2020 , Evangelou et al, 2020 , Loonstra et al, 2020 , Preziosa et al, 2020 ) 35 56 91 0 Ocrelizumab ( Louapre et al, 2020 , Parrotta et al, 2020 , Ciampi et al, 2020 , Sahraian et al, 2020 , Chaudhry et al, 2020 , Maillart et al, 2020 , Ciampi et al, 2020 , Crescenzo et al, 2020 , ...…”

Alemtuzumab in Covid era

“…To the best of our knowledge, only seven other similar cases have been published [table 2]. These similar cases, with uncomplicated COVID-19 infection despite alemtuzumab-induced lymphopenia, have been described at different time: one week [13,17], two months [14], three months [15] and one year [15,17] after the alemtuzumab infusion.…”

Experience in Multiple Sclerosis Patients with COVID-19 and Disease-Modifying Therapies: A Review of 873 Published Cases

“…The best search term with 279 hits turned out to be coronavirus_multiple sclerosis. Finally, all case reports as well as all case series and larger studies which contained information on the different DMTs and the outcome of the respective patients were included [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ].…”