Artigos Recomendados

Artigos Recomendados


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Confira abaixo os artigos recomendados pelo CIEM sobre esclerose múltipla e espectro de neuromielite óptica:

  • Neurological immunotherapy in the era of COVID-19 — looking for consensus in literature - Nature Reviews Neurology, 2020
     
  • Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders - Neurology: Neuroimmunology & Neuroinflammation, 2020
     
  • COVID-19 and MS disease-modifying therapies - Neurology: Neuroimmunology & Neuroinflammation, 2020
     
  • Effects of exercise training on multiple sclerosis biomarkers of central nervous system and disease status: a systematic review of intervention studies - European Journal of Neurology, 2019
     
  • A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project - Journal of Neurology, 2020
     
  • Association Between Breastfeeding and Postpartum Multiple Sclerosis Relapses - A Systematic Review and Meta-analysis - JAMA Neurology, 2019
     
  • Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis - American Academy of Neurology, 2019 
     
  • Effectiveness and tolerability of immunosuppressants and monoclonal antibodies in preventive treatment of neuromyelitis optica spectrum disorders: A systematic review and network meta-analysis - Multiple Sclerosis and Related Disorders, 2019
     
  • Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria - The Lancet, 2018
     
  • Association of MOG-IgG Serostatus With Relapse After Acute Disseminated Encephalomyelitis and Proposed Diagnostic Criteria for MOG-IgG-Associated Disorders - JAMA Neurology, 2018
     
  • Vaccines and multiple sclerosis: a systematic review - Journal of Neurology, 2017
     
  • Cognitive dysfunction in adult patients with neuromyelitis optica: a systematic review and meta-analysis - Journal of Neurology, 2017
     
  • Efficacy and Safety of Rituximab Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-analysis - JAMA Neurology, 2016
     
  • Defining the clinical course of multiple sclerosis - the 2013 revisions - American Academy of Neurology, 2014 

Neurological immunotherapy in the era of COVID-19 — looking for consensus in literature - Nature Reviews Neurology, 2020

  • Abstract:

The coronavirus disease 2019 (COVID-19) pandemic is concerning for patients with neuroimmunological diseases who are receiving immunotherapy. Uncertainty remains about whether immunotherapies increase the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or increase the risk of severe disease and death upon infection. National and international societies have developed guidelines and statements, but consensus does not exist in several areas. In this Review, we attempt to clarify where consensus exists and where uncertainty remains to inform management approaches based on the first principles of neuroimmunology. We identified key questions that have been addressed in the literature and collated the recommendations to generate a consensus calculation in a Delphi-like approach to summarize the information. We summarize the international recommendations, discuss them in light of the first available data from patients with COVID-19 receiving immunotherapy and provide an overview of management approaches in the COVID-19 era. We stress the principles of medicine in general and neuroimmunology in particular because, although the risk of viral infection has become more relevant, most of the considerations apply to the general management of neurological immunotherapy. We also give special consideration to immunosuppressive treatment and cell-depleting therapies that might increase susceptibility to SARS-CoV-2 infection but reduce the risk of severe COVID-19.

  • DOI:

 https://doi.org/10.1038/s41582-020-0385-8

Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders - Neurology: Neuroimmunology & Neuroinflammation, 2020

  • Abstract:

Objective

Disease-modifying drugs (DMDs) may alter the immune status and thus increase the sus- ceptibility to coronavirus disease 2019 (COVID-19) in patients with MS or neuromyelitis optica spectrum disorders (NMOSD). However, evidence supporting this notion is currently lacking. In this study, we conducted a survey on the risk of COVID-19 in patients with MS and NMOSD.

Methods

The survey was conducted through the Chinese Medical Network for Neuroinflammation. Patients in 10 MS centers from 8 cities including Wuhan were included. Information about MS and NMOSD disease duration and the usage of DMDs were collected. Data of suspected cases of COVID-19 were obtained from hospital visits, questionnaires, and patient self-reporting. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was confirmed through clinical evaluation by a panel of experts in conjunction with chest CT and viral RNA detection.

Results

Eight hundred eighty-two of 1,804 (48.89%) patients with MS and 2,129 of 3,060 (69.58%) patients with NMOSD were receiving DMDs. There were no alterations in the patientsDMD regimen during January 15, 2020, to March 15, 2020, the 3-month period. None of the patients with MS treated with DMDs had COVID-19. However, 2 patients with relapsing NMOSD were diagnosed with COVID-19-related pneumonia. After treatment, both patients recovered from pneumonia and neither patient experienced new attacks due to predisposing SARS-CoV-2 infection in the following 2 months.

Conclusions

No increased risk of COVID-19 infection was observed in patients with MS or NMOSD, irrespective of whether these patients received DMDs. A battery of stringent preventive measures adopted by neurologists to reduce COVID-19 infection in these patients may have contributed to low risk of COVID-19 infection.

  • DOI:

https://doi.org/10.1212/NXI.0000000000000787

COVID-19 and MS disease-modifying therapies - Neurology: Neuroimmunology & Neuroinflammation, 2020

  • Abstract:

Objective

To address concerns regarding the effect of MS disease-modifying therapies (DMTs) on the expression of coronavirus 2019 (COVID-19).

Methods

Review of the current state of knowledge regarding the viral etiology of COVID-19, mecha- nisms of injury by SARS-CoV-2 infection, and the effect of individual DMTs on the risk of infection and COVID-19 disease expression.

Results

Although data are limited, MS DMTs do not obviously increase the risk of acquiring symp- tomatic SARS-CoV-2 infection. The severe morbidity and mortality of SARS-CoV-2 appear to be largely the consequence of an overly robust immune response rather than the consequence of unchecked viral replication. The effects of specific MS DMTs on the immune response that may increase the risk of impaired viral clearance and their potential counterbalancing beneficial effects on the development of COVID-19–associated acute respiratory distress syndrome are reviewed.

Conclusion

Although there is currently insufficient real-world experience to definitively answer the question of the effect of a specific MS DMT on COVID-19, registries presently in nascent form should provide these answers. This review provides an approach to addressing these concerns while the data are being accumulated. Early insights suggest that the risk of infection and associated morbidity of COVID-19 in this population is little different than that of the population at large.

  • DOI:

https://doi.org/10.1212/NXI.0000000000000761

A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project - Journal of Neurology, 2020

  • Abstract:

Neurologists managing women with Multiple Sclerosis (MS) need information about the safety of disease modifying drugs (DMDs) during pregnancy. However, this knowledge is limited. The present study aims to summarize previous studies by performing a systematic review and meta-analyses. The terms "multiple sclerosis" combined with DMDs of interest and a broad profile for pregnancy terms were used to search Embase and Medline databases to identify relevant studies published from January 2000 to July 2019.1260 studies were identified and ten studies met our inclusion criteria. Pooled risk ratios (RR) of pregnancy and birth outcomes in pregnancies exposed to DMDs compared to those not exposed were calculated using a random effects model. For spontaneous abortion RR = 1.14, 95% CI 0.99-1.32, for preterm births RR = 0.93, 95% CI 0.72-1.21 and for major congenital malformations RR = 0.86, 95% CI 0.47-1.56. The most common major congenital malformations reported in MS patients exposed to MS drugs were atrial septal defect (ASD) (N = 4), polydactyly (N = 4) and club foot (N = 3), which are among the most prevalent birth defects observed in the general population. In conclusion, interferons, glatiramer acetate or natalizumab, do not appear to increase the risk for spontaneous abortions, pre-term birth or major congenital malformations. There were very few patients included that were exposed to fingolimod, azathioprine and rituximab; therefore, these results cannot be generalized across drugs. Future studies including internal comparators are needed to enable treating physicians and their patients to decide on the best treatment options.

  • DOI:

https://doi.org/10.1007/s00415-020-09913-1

Association Between Breastfeeding and Postpartum Multiple Sclerosis Relapses - A Systematic Review and Meta-analysis - JAMA Neurology, 2019

  • Abstract:

Importance: Multiple sclerosis (MS) relapses may be increased in the postpartum period, and whether breastfeeding is associated with reduction in the risk of postpartum relapses remains controversial.

Objective: To perform a systematic review and meta-analysis to evaluate whether breastfeeding is associated with reduction in postpartum MS relapses compared with not breastfeeding.

Data sources: PubMed and Embase were searched for studies assessing the association between breastfeeding and MS disease activity published between January 1, 1980, and July 11, 2018, as well as reference lists of selected articles.

Study selection: All study designs assessing the association between breastfeeding and postpartum relapses in MS relative to a comparator group were included.

Data extraction and synthesis: Study eligibility assessment and extraction of study characteristics, methods, and outcomes, were performed independently by 2 reviewers following PRISMA guidelines. Risk of bias was evaluated by 2 independent reviewers with the ROBINS-I tool for nonrandomized, interventional studies. Findings from studies with data available for the number of women with postpartum relapses in the breastfeeding and nonbreastfeeding groups were combined with a random-effects model.

Main outcomes and measures: Postpartum MS relapse.

Results: The search identified 462 unique citations, and 24 (2974 women) satisfied eligibility criteria and were included, of which 16 were included in the quantitative meta-analysis. The pooled summary odds ratio for the association of breastfeeding with postpartum relapses was 0.63 (95% CI, 0.45-0.88; P = .006) compared with a reference of nonbreastfeeding. Pooled adjusted hazard ratio across 4 studies that reported this finding was 0.57 (95% CI, 0.38-0.85; P = .006). There was moderate heterogeneity (I2 = 48%), which was explained by variable prepregnancy relapse rate, postpartum follow-up duration, and the publication year. A stronger association was seen in studies of exclusive rather than nonexclusive breastfeeding, although both demonstrated an association. Studies were rated at moderate and serious risk of bias, with concern for residual confounding, although sensitivity analysis including only moderate quality studies was consistent with a protective outcome of breastfeeding.

Conclusions and relevance: These findings suggest that breastfeeding is protective against postpartum relapses in MS, although high-quality prospective studies to date are limited and well-designed observational studies that aim to emulate a randomized trial would be of benefit.

  • DOI:

https://doi.org/10.1001/jamaneurol.2019.4173

Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis - American Academy of Neurology, 2019 

  • Abstract:

Objective: To update the 2002 American Academy of Neurology (AAN) guideline regarding immunization and multiple sclerosis (MS).

Methods: The panel performed a systematic review and classified articles using the AAN system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended.

Major recommendations level b except where indicated: Clinicians should discuss the evidence regarding immunizations in MS with their patients and explore patients' opinions, preferences, and questions. Clinicians should recommend that patients with MS follow all local vaccine standards, unless there are specific contraindications and weigh local vaccine-preventable disease risks when counseling patients. Clinicians should recommend that patients with MS receive the influenza vaccination annually. Clinicians should counsel patients with MS about infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information (PI) and vaccinate patients with MS as needed at least 4-6 weeks before initiating patients' ISIM therapy. Clinicians must screen for infections according to PI before initiating ISIM medications (Level A) and should treat patients testing positive for latent infections. In high-risk populations, clinicians must screen for latent infections before starting ISIM therapy even when not specifically mentioned in PI (Level A) and should consult specialists regarding treating patients who screen positive for latent infection. Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies. Clinicians should delay vaccinating people with MS who are experiencing a relapse.

© 2019 American Academy of Neurology.

  • DOI:

https://doi.org/10.1212/wnl.0000000000008157

Effects of exercise training on multiple sclerosis biomarkers of central nervous system and disease status: a systematic review of intervention studies - European Journal of Neurology, 2019

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  • DOI:

https://doi.org/10.1111/ene.13929

Effectiveness and tolerability of immunosuppressants and monoclonal antibodies in preventive treatment of neuromyelitis optica spectrum disorders: A systematic review and network meta-analysis - Multiple Sclerosis and Related Disorders, 2019

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  • DOI:

https://doi.org/10.1016/j.msard.2019.08.009

Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria - The Lancet, 2018

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  • DOI:

https://doi.org/10.1016/S1474-4422(17)30470-2

Association of MOG-IgG Serostatus With Relapse After Acute Disseminated Encephalomyelitis and Proposed Diagnostic Criteria for MOG-IgG-Associated Disorders - JAMA Neurology, 2018

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  • DOI:

https://dx.doi.org/10.1001%2Fjamaneurol.2018.1814

Vaccines and multiple sclerosis: a systematic review - Journal of Neurology, 2017

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  • DOI:

https://doi.org/10.1007/s00415-016-8263-4

Cognitive dysfunction in adult patients with neuromyelitis optica: a systematic review and meta-analysis - Journal of Neurology, 2017

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  • DOI:

https://doi.org/10.1007/s00415-016-8345-3

Efficacy and Safety of Rituximab Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-analysis - JAMA Neurology, 2016

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  • DOI:

https://doi.org/10.1001/jamaneurol.2016.1637

Defining the clinical course of multiple sclerosis - the 2013 revisions - American Academy of Neurology, 2014 

  • Abstract:

Accurate clinical course descriptions (phenotypes) of multiple sclerosis (MS) are important for communication, prognostication, design and recruitment of clinical trials, and treatment decision-making. Standardized descriptions published in 1996 based on a survey of international MS experts provided purely clinical phenotypes based on data and consensus at that time, but imaging and biological correlates were lacking. Increased understanding of MS and its pathology, coupled with general concern that the original descriptors may not adequately reflect more recently identified clinical aspects of the disease, prompted a re-examination of MS disease phenotypes by the International Advisory Committee on Clinical Trials of MS. While imaging and biological markers that might provide objective criteria for separating clinical phenotypes are lacking, we propose refined descriptors that include consideration of disease activity (based on clinical relapse rate and imaging findings) and disease progression. Strategies for future research to better define phenotypes are also outlined.

Neurology® 2014;83:278–286

  • DOI:

https://doi.org/10.1212/wnl.0000000000000560