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01-10-2020 | Coronavirus | Original Communication

COVID-19 in teriflunomide-treated patients with multiple sclerosis

Authors: Amir Hadi Maghzi, Maria K. Houtchens, Paolo Preziosa, Carolina Ionete, Biljana D. Beretich, James M. Stankiewicz, Shahamat Tauhid, Ann Cabot, Idanis Berriosmorales, Tamara H. W. Schwartz, Jacob A. Sloane, Mark S. Freedman, Massimo Filippi, Howard L. Weiner, Rohit Bakshi

Published in: Journal of Neurology | Issue 10/2020

Abstract

The outbreak of a severe acute respiratory syndrome caused by a novel coronavirus (COVID-19), has raised health concerns for patients with multiple sclerosis (MS) who are commonly on long-term immunotherapies. Managing MS during the pandemic remains challenging with little published experience and no evidence-based guidelines. We present five teriflunomide-treated patients with MS who subsequently developed active COVID-19 infection. The patients continued teriflunomide therapy and had self-limiting infection, without relapse of their MS. These observations have implications for the management of MS in the setting of the COVID-19 pandemic.

Guan W, Ni Z, Hu Y et al (2020) Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 382:1708–1720. https://doi.org/10.1056/NEJMoa2002032CrossRefPubMed

Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395:1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3CrossRefPubMedPubMedCentral

Cunningham AC, Goh HP, Koh D (2020) Treatment of COVID-19: old tricks for new challenges. Crit Care 24:91. https://doi.org/10.1186/s13054-020-2818-6CrossRefPubMedPubMedCentral

Mahase E (2020) Covid-19: what treatments are being investigated? BMJ 368:m1252. https://doi.org/10.1136/bmj.m1252CrossRefPubMed

Cao B, Wang Y, Wen D et al (2020) A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 382:1787–1799. https://doi.org/10.1056/NEJMoa2001282CrossRefPubMed

NIH clinical trial shows remdesivir accelerates recovery from advanced COVID-19. https://www.nih.gov/news-events/news-releases/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19. Accessed 15 May 2020

Wallin MT, Culpepper WJ, Campbell JD et al (2019) The prevalence of MS in the United States: a population-based estimate using health claims data. Neurology 92:e1029–e1040. https://doi.org/10.1212/WNL.0000000000007035CrossRefPubMedPubMedCentral

Luna G, Alping P, Burman J et al (2020) Infection risks among patients with multiple sclerosis treated with fingolimod, natalizumab, rituximab, and injectable therapies. JAMA Neurol 77:184–191. https://doi.org/10.1001/jamaneurol.2019.3365CrossRefPubMed

Karamyan A, Dünser MW, Wiebe DJ et al (2016) Critical illness in patients with multiple sclerosis: a matched case-control study. PLoS ONE 11:e0155795. https://doi.org/10.1371/journal.pone.0155795CrossRefPubMedPubMedCentral

10.

Montgomery S, Hillert J, Bahmanyar S (2013) Hospital admission due to infections in multiple sclerosis patients. Eur J Neurol 20:1153–1160. https://doi.org/10.1111/ene.12130CrossRefPubMed

11.

Steelman AJ (2015) Infection as an environmental trigger of multiple sclerosis disease exacerbation. Front Immunol 6:520. https://doi.org/10.3389/fimmu.2015.00520CrossRefPubMedPubMedCentral

12.

Giovannoni G, Hawkes C, Lechner-Scott J et al (2020) The COVID-19 pandemic and the use of MS disease-modifying therapies. Mult Scler Relat Disord 39:102073. https://doi.org/10.1016/j.msard.2020.102073CrossRefPubMedPubMedCentral

13.

Barry B, Erwin AA, Stevens J, Tornatore C (2019) Fingolimod rebound: a review of the clinical experience and management considerations. Neurol Ther 8:241–250. https://doi.org/10.1007/s40120-019-00160-9CrossRefPubMedPubMedCentral

14.

Kim W, Kim S-H, Huh S-Y et al (2013) Reduced antibody formation after influenza vaccination in patients with neuromyelitis optica spectrum disorder treated with rituximab. Eur J Neurol 20:975–980. https://doi.org/10.1111/ene.12132CrossRefPubMed

15.

Sormani MP (2020) An Italian programme for COVID-19 infection in multiple sclerosis. Lancet Neurol. https://doi.org/10.1016/S1474-4422(20)30147-2[Epub ahead of print, April 30, 2020]CrossRefPubMedPubMedCentral

16.

Novi G, Mikulska M, Briano F et al (2020) COVID-19 in a MS patient treated with ocrelizumab: does immunosuppression have a protective role. Mult Scler Relat Disord. https://doi.org/10.1016/j.msard.2020.102120[Epub ahead of print, April 15, 2020]CrossRefPubMedPubMedCentral

17.

Barzegar M, Mirmosayyeb O, Nehzat N et al (2020) COVID-19 infection in a patient with multiple sclerosis treated with fingolimod. Neurol Neuroimmunol Neuroinflamm 7:e753. https://doi.org/10.1212/NXI.0000000000000753CrossRefPubMedPubMedCentral

18.

Lebrun C (2015) The radiologically isolated syndrome. Rev Neurol (Paris) 171:698–706. https://doi.org/10.1111/jon.12182CrossRef

19.

Shi Y, Wang Y, Shao C et al (2020) COVID-19 infection: the perspectives on immune responses. Cell Death Differ 27:1451–1454. https://doi.org/10.1038/s41418-020-0530-3CrossRefPubMedPubMedCentral

20.

Smits SL, de Lang A, van den Brand JMA et al (2010) Exacerbated innate host response to SARS-CoV in aged non-human primates. PLoS Pathog 6:e1000756. https://doi.org/10.1371/journal.ppat.1000756CrossRefPubMedPubMedCentral

21.

Pinti M, Appay V, Campisi J et al (2016) Aging of the immune system: focus on inflammation and vaccination. Eur J Immunol 46:2286–2301CrossRefPubMedPubMedCentral

22.

Bar-Or A, Pachner A, Menguy-Vacheron F et al (2014) Teriflunomide and its mechanism of action in multiple sclerosis. Drugs 74:659–674. https://doi.org/10.1007/s40265-014-0212-xCrossRefPubMedPubMedCentral

23.

Bar-Or A, Freedman MS, Kremenchutzky M et al (2013) Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis. Neurology 81:552–558. https://doi.org/10.1212/WNL.0b013e31829e6fbfCrossRefPubMedPubMedCentral

24.

Bar-Or A, Wiendl H, Miller B et al (2015) Randomized study of teriflunomide effects on immune responses to neoantigen and recall antigens. Neurol Neuroimmunol NeuroInflamm 2:e70. https://doi.org/10.1212/NXI.0000000000000070CrossRefPubMedPubMedCentral

25.

Mei-jiao G, Shi-fang L, Yan-yan C et al (2019) Antiviral effects of selected IMPDH and DHODH inhibitors against foot and mouth disease virus. Biomed Pharmacother 118:1–7. https://doi.org/10.1016/j.biopha.2019.109305CrossRef

26.

Gilli F, Li L, Royce DB et al (2017) Treatment of Theiler’s virus-induced demyelinating disease with teriflunomide. J Neurovirol 23:825–838. https://doi.org/10.1007/s13365-017-0570-8CrossRefPubMed

27.

Bilger A, Plowshay J, Ma S et al (2017) Leflunomide/teriflunomide inhibit Epstein-barr virus (EBV)-induced lymphoproliferative disease and lytic viral replication. Oncotarget 8:44266–44280. https://doi.org/10.18632/oncotarget.17863CrossRefPubMedPubMedCentral

28.

Martin S, Chiramel AI, Schmidt ML et al (2018) A genome-wide siRNA screen identifies a druggable host pathway essential for the Ebola virus life cycle. Genome Med 10:58. https://doi.org/10.1186/s13073-018-0570-1CrossRefPubMedPubMedCentral

29.

Xiong R, Zhang L, Li S et al (2020) Novel and potent inhibitors targeting DHODH, a rate-limiting enzyme in de novo pyrimidine biosynthesis, are broad-spectrum antiviral against RNA viruses including newly emerged coronavirus SARS-CoV-2. BioRxiv. https://doi.org/10.1101/2020.03.11.983056CrossRefPubMedPubMedCentral

30.

Warnke C, Stüve O, Kieseier BC (2013) Teriflunomide for the treatment of multiple sclerosis. Clin Neurol Neurosurg 115:90–94. https://doi.org/10.1016/j.clineuro.2013.09.030CrossRef

Title: COVID-19 in teriflunomide-treated patients with multiple sclerosis
Authors: Amir Hadi Maghzi
Maria K. Houtchens
Paolo Preziosa
Carolina Ionete
Biljana D. Beretich
James M. Stankiewicz
Shahamat Tauhid
Ann Cabot
Idanis Berriosmorales
Tamara H. W. Schwartz
Jacob A. Sloane
Mark S. Freedman
Massimo Filippi
Howard L. Weiner
Rohit Bakshi
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Coronavirus
Multiple Sclerosis
COVID-19
Teriflunomide
Published in: Journal of Neurology / Issue 10/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-020-09944-8

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COVID-19 in teriflunomide-treated patients with multiple sclerosis

Abstract

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Abstract

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