Spontaneous multiple cervical artery dissections after alemtuzumab

Durand‐Dubief, Françoise; Marignier, Romain; Berthezène, Yves; Cottin, Judith; Nighoghossian, Norbert; Vukusic, Sandra

doi:10.1177/1352458519828663

Cited by 17 publications

(13 citation statements)

References 8 publications

(8 reference statements)

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“…This approach has been proposed by several published expert opinions and treatment guidelines including those published by the Association of British Neurologists and the Italian Society of Neurology [90,91]. Another important factor that supports delaying treatment in infected patients or who are at high risk of catching the infection is the link between alemtuzumab and the risk of stroke and cervicocephalic arterial dissection [92,93]. This might augment the COVID-19-related risk of thrombosis and intracerebral hemorrhage [94] if patients are re-dosed with alemtuzumab during infection or if they catch the infection shortly after redosing.…”

Section: Potential Relevance To the Covid-19 Pandemic And Possible Rimentioning

confidence: 99%

Multiple Sclerosis Disease-Modifying Therapy and the COVID-19 Pandemic: Implications on the Risk of Infection and Future Vaccination

et al. 2020

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The coronavirus 2019 (COVID-19) pandemic is expected to linger. Decisions regarding initiation or continuation of diseasemodifying therapy for multiple sclerosis have to consider the potential relevance to the pandemic. Understanding the mechanism of action and the possible idiosyncratic effects of each therapeutic agent on the immune system is imperative during this special time. The infectious side-effect profile as well as the route and frequency of administration of each therapeutic agent should be carefully considered when selecting a new treatment or deciding on risk mitigation strategies for existing therapy. More importantly, the impact of each agent on the future severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2) vaccine should be carefully considered in treatment decisions. Moreover, some multiple sclerosis therapies may have beneficial antiviral effects against SARS-CoV-2 while others may have beneficial immune-modulating effects against the cytokine storm and hyperinflammatory phase of the disease. Conventional injectables have a favorable immune profile without an increased exposure risk and therefore may be suitable for mild multiple sclerosis during the pandemic. However, moderate and highly active multiple sclerosis will continue to require treatment with oral or intravenous high-potency agents but a number of risk mitigation strategies may have to be implemented. Immune-modulating therapies such as the fumerates, sphinogosine-1P modulators, and natalizumab may be anecdotally preferred over cell-depleting immunosuppressants during the pandemic from the immune profile standpoint. Within the cell-depleting agents, selective (ocrelizumab) or preferential (cladribine) depletion of B cells may be relatively safer than non-selective depletion of lymphocytes and innate immune cells (alemtuzumab). Patients who develop severe iatrogenic or idiosyncratic lymphopenia should be advised to maintain social distancing even in areas where lockdown has been removed or ameliorated. Patients with iatrogenic hypogammaglobulinemia may require prophylactic intravenous immunoglobulin therapy in certain situations. When the future SARS-CoV-2 vaccine becomes available, patients with multiple sclerosis should be advised that certain therapies may interfere with mounting a protective immune response to the vaccine and that serological confirmation of a response may be required after vaccination. They should also be aware that most multiple sclerosis therapies are incompatible with live vaccines if a live SARS-CoV-2 vaccine is developed. In this article, we review and compare disease-modifying therapies in terms of their effect on the immune system, published infection rates, potential impact on SARS-CoV-2 susceptibility, and vaccine-related implications. We propose risk mitigation strategies and practical approaches to disease-modifying therapy during the COVID-19 pandemic.

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Section: Potential Relevance To the Covid-19 Pandemic And Possible Rimentioning

confidence: 99%

Multiple Sclerosis Disease-Modifying Therapy and the COVID-19 Pandemic: Implications on the Risk of Infection and Future Vaccination

et al. 2020

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“…These encompass acute cardiovascular events such as acute coronary artery syndrome or myocardial ischemia, as well as ischemic and hemorrhagic strokes. 8–10…”

mentioning

confidence: 99%

Alemtuzumab: Rare serious adverse events of a high-efficacy drug

2020

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“…Durand-Dubief et al reported a case of multiple cervical arterial dissections days after treatment with alemtuzumab. 1 Five cases of intracerebral haemorrhage were recently reported by Azevedo et al 2 In November 2018, this concern prompted the United States Food and Drug Administration (FDA) to add the risk of stroke within three days of administration to the boxed warning on the drug's label. 3 The FDA commented on the possible causative role of cytokine release syndrome, but decided there was insufficient evidence.…”

Section: Highlightsmentioning

confidence: 99%