突破性COVID-19在多发性硬化症患者中的疾病修饰治疗:它仍然是一个严重的疾病吗?
Paolo Immovilli1, Irene Schiavetti2, Alessandro Franceschini3
1Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, via Taverna 38, Piacenza 29121, Italy.
接受B细胞抑制剂疾病修饰治疗 (DMT) 的多发性硬化症 (MS) 患者面临更高的突破性COVID-19感染风险. 然而,疫苗接种有效地保护这种人群免受严重疾病的影响.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
背景情况:
- 改变疾病的治疗 (DMT) 对于治疗多发性硬化症 (MS) 至关重要,但高效的治疗 (HET) 可能会增加感染风险.
- 接种疫苗对于保护HET上多发性硬化症 (pwMS) 患者至关重要,特别是针对COVID-19等感染.
- 了解MS DMTs对COVID-19疫苗有效性和突破性感染风险的影响对于患者安全至关重要.
研究的目的:
- 评估各种MS DMT对COVID-19疫苗接种反应的影响.
- 评估不同DMT治疗的 pwMS 中突破性COVID-19感染的风险.
- 为了确定特定的DMT是否与疫苗接种后COVID-19感染风险增加有关.
主要方法:
- 在专门的多发性硬化中心进行了一项单心回顾性观察研究.
- 分析了157名接受了两剂COVID-19疫苗的pwMS (其中80.3%接受了增强剂).
- 包括多变量线性回归在内的统计模型被用于识别与抗体标位和突破性感染相关的因素.
主要成果:
- 观察到25例突破性COVID-19感染 (15.9%),大多数为轻度 (68.0%) 或中度 (32.0%).
- B细胞抑制剂DMT和较高的EDSS得分与较低的抗体标位有关.
- 服用B细胞抑制剂的患者患突破性感染的风险几乎增加了四倍 (HR:3.72,p=0.005).
结论:
- B细胞抑制剂DMT与pWMS中突破COVID-19感染的风险增加有关.
- 尽管这种风险增加,但COVID-19疫苗接种在研究队列中提供了对严重疾病的全面保护.
- 接种疫苗仍然是pwMS的关键预防策略,即使是那些接受免疫抑制疗法的人.
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