COVID-19 in cladribine-treated relapsing-remitting multiple sclerosis patients: a monocentric experience
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LETTER TO THE EDITORS
COVID‑19 in cladribine‑treated relapsing‑remitting multiple sclerosis patients: a monocentric experience Paolo Preziosa1,2 · Maria A. Rocca1,2,5 · Agostino Nozzolillo2 · Lucia Moiola2 · Massimo Filippi1,2,3,4,5 Received: 27 August 2020 / Revised: 2 November 2020 / Accepted: 8 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sirs,
Case report
Cladribine is a purine nucleoside analog that inhibits DNA synthesis and repair in highly dividing cells inducing B- and T-cell apoptosis [1]. Through a selective but transient depletion of these lymphocyte subsets [1, 5], cladribine significantly reduces disease activity and disability progression in relapsing–remitting multiple sclerosis (RRMS) patients [2–4]. The SARS-CoV-2 pandemic has raised several concerns regarding the use of immunosuppressants in RRMS patients [6], since they are vulnerable to infections due to their disability and the use of drugs acting specifically on the immune system [7]. However, the influence of cladribine on the risk of developing COVID-19 disease is still unclear. Only two case series with three RRMS patients reported no or mild COVID-19 disease [8] or moderate pneumonia [9]. Here, we evaluated the prevalence and clinical features of COVID-19 disease among RRMS patients treated with cladribine in our center in Lombardy, Italy. From the whole MS population of our center, those treated with cladribine (Table 1) were asked if they had developed manifestations suggestive of COVID-19 disease up to August 25th 2020. Detailed demographic, clinical, and laboratoristic characteristics were collected.
Since the pandemic start, 2/56 (3.6%) RRMS treated with cladribine complained a symptomatology suggestive of COVID-19 disease. The first RRMS patient is a 30-year-old male, with a short disease duration (1.4 years), mild disability (Expanded Disability Status Scale [EDSS] score = 1.5), and no comorbidities (Table 2). He started cladribine on January 10th 2020. One week later, he developed fever (
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