1) Welcome to this #tweetorial on #MultipleSclerosis & #COVID19 severity–including the role of #MS #DMTs – as well as an update on COVID #vaccines, #boosters, and implications for future MS care. I am @GavinGiovannoni and program chair @SKriegerMD and I invite you to follow us! pic.twitter.com/fxj5D7ZVrp
— MultipleSclerosis_CME (@ms_cme) October 4, 2021
3) Let’s start by highlighting what we’ve learned about MS and COVID-19 itself.
MS itself does not increase the chances of getting COVID-19. The risk factors for severe COVID-19 in patients with MS . . .— MultipleSclerosis_CME (@ms_cme) October 4, 2021
5) MS disability is independently assoc'd with worse clinical severity including death from COVID-19. Other risk factors for poor outcomes include black race, cardiovascular comorbidities, and recent treatment with steroids. #GetVaccinatedASAP
doi: 10.1001/jamaneurol.2021.0688 pic.twitter.com/3agk0QYq8B— MultipleSclerosis_CME (@ms_cme) October 4, 2021
7) COVID-19 is associated with systemic inflammatory response and a temperature that may cause transient worsening of symptoms, or a pseudo relapse, in previously damaged pathways. pic.twitter.com/Ptr4djXXan
— MultipleSclerosis_CME (@ms_cme) October 4, 2021
9) Patients with multiple sclerosis are susceptible to long-COVID that adds to their burden of MS. See Mult Scler Relat Disord. 2021 Jul 22;54:103163. doi: 10.1016/j.msard.2021.103163. #LongCOVID #StayVigilant #GetVaccinatedASAP pic.twitter.com/2FyKMfJOqz
— MultipleSclerosis_CME (@ms_cme) October 4, 2021
11) COVID-19 has had a major psychological impact on #pwMS with more depressive symptoms, poor sleep quality and increased fatigue levels. How do we build psychological resilience in pwMS? Front Neurol. 2020 Oct 30;11:580507. doi: 10.3389/fneur.2020.580507. pic.twitter.com/RH9qUWPwWh
— MultipleSclerosis_CME (@ms_cme) October 4, 2021
13) Mark your answer and return TOMORROW for more education from @GavinGiovannoni! You're on your way to FREE CE for #nurses and #pharmacists and FREE #CME for #physicians! And see our past programs, still available for credit, at https://t.co/UxJJ4faaJJ!
— MultipleSclerosis_CME (@ms_cme) October 4, 2021
15) Anti-CD20 therapies, rituximab, ocrelizumab and probably ofatumumab, double the risk of severe COVID-19 and blunt humoral or antibody responses to SARS-CoV-2, which is likely to reduce protection against reinfection with new variants. See doi: 10.1002/ana.26028. pic.twitter.com/12Ope8AxnL
— MultipleSclerosis_CME (@ms_cme) October 5, 2021
17) People with MS on glatiramer acetate appear to have the same risk of getting severe COVID-19 as people in the general population. This is because glatiramer acetate is not immunosuppressive. See Ann Neurol. 2021 Apr;89(4):780-789. doi: 10.1002/ana.26028. pic.twitter.com/xPyXTGBRY6
— MultipleSclerosis_CME (@ms_cme) October 5, 2021
19) People w/MS on fumarates (DMF & diroximel fumarate) appear to have the same risk of getting severe COVID-19 as the general population, because fumarates are in general only mild immunosuppressives. Mult Scler Relat Disord. 2020 Nov;46:102566. doi: 10.1016/j.msard.2020.102566. pic.twitter.com/Eiz5msDIiW
— MultipleSclerosis_CME (@ms_cme) October 5, 2021
21) During the pandemic I have been using a lot more natalizumab, even in JCV-positive patients, to get on top of MS disease activity without systemic immunosuppression and to maintain vaccine readiness. Natalizumab = #Time2ThinkDMT pic.twitter.com/FCKlXBfen7
— MultipleSclerosis_CME (@ms_cme) October 5, 2021
23) Now we will turn to 🔑 questions about COVID-19 vaccinations and boosters for pwMS. The risk that COVID-19 poses to people w/MS are orders of magnitude higher than the risk of severe adverse events from the vaccines. #GetVaccinatedASAP See doi: 10.1016/j.msard.2021.103163 pic.twitter.com/qBSk6Knr4i
— MultipleSclerosis_CME (@ms_cme) October 5, 2021
25) COVID-19 vaccines are safe in people with MS and have not been shown to trigger a relapse. See Eur J Neurol. 2021 Jul 21. doi: 10.1111/ene.15028. pic.twitter.com/2QHLY0cEEH
— MultipleSclerosis_CME (@ms_cme) October 5, 2021
26) Tomorrow we'll talk about "pseudo-relapse" in #multiplesclerosis after #COVID19 #vaccination, and we'll provide a link to your free CE/#CME credit! @RayDorsey7 @RanyAburashed @drbarrysinger @DrJNicholas @SKriegerMD @AANMember @MarisaMcGinley @GMacaronMD @sumadshah
— MultipleSclerosis_CME (@ms_cme) October 5, 2021
28) COVID-19 vaccines may cause transient worsening of symptoms, or a pseudo relapse, in previously damaged pathways. This is a form of Uhtoff’s phenomenon or temperature-related conduction block. pic.twitter.com/iKO81leiWc
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
30) Antibody responses to COVID-19 in patients with MS on disease-modifying therapies, with the exception of anti-CD20 and fingolimod, are maintained. See https://t.co/gwf98XxS3u . pic.twitter.com/LkQKUxWMMc
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
32) Antibody responses to the COVID-19 vaccine are seen when B-cell reconstitute after anti-CD20 therapies. Does this mean we should interrupt dosing with anti-CD20 therapies? See https://t.co/mUFIBgdDtT
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
34) Whether or not you need to delay your next dose of anti-CD20 before having your booster COVID-19 vaccine is debatable. If you are at high risk of severe COVID-19 you may want to wait and optimise your antibody response. #WhenToGetBoosted. See https://t.co/3FfSZ8IDuH pic.twitter.com/oH7qkOvUri
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
36) Good news for pwMS with blunted vaccine responses or who are unvaccinated: we now have REGEN-COV, a combo of the monoclonal antibodies (casirivimab+imdevimab) to prevent and treat COVID-19; this makes COVID-19 less life-threatening. See N Engl J Med 2021;385(13):1184-1195. pic.twitter.com/FnE7mHrgM7
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
38) . . . is important for counselling patients about risks of infection and vaccine readiness. See J Neuroimmunol. 2021 Aug 15;357:577627. doi: 10.1016/j.jneuroim.2021.577627. pic.twitter.com/djEqkpAChg
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
40) Comorbidities matter in pwMS; identifying, treating & preventing them, particularly in ethnic minority & other vulnerable groups, means that post-COVID we are going to have to rethink our management pathways. #MangeMSHolistically. See Mult Scler. 2021;30:13524585211031791. pic.twitter.com/QMoUckdDUh
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
42) What can we learn from COVID-19 about de-risking chronic immunosuppression in older patients with MS?
Aging Dis. 2021;12(5):1272-1286. doi: 10.14336/AD.2021.0106. pic.twitter.com/QHRZeCxON2— MultipleSclerosis_CME (@ms_cme) October 6, 2021
44) . . . in doing so, consider JMIR Rehabil Assist Technol. 2018 Apr 24;5(1):e5. doi: 10.2196/rehab.7805. pic.twitter.com/kmyXaN50ZI
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
45) That's it! You made it! You just earned 0.5h CE/#CME and you can claim it with a quick visit to https://t.co/mvX4lAbk1D. I am @GavinGiovannoni and program chair @SKriegerMD and I hope that you will FOLLOW @ms_cme for more expert education on #MultipleSclerosis !
— MultipleSclerosis_CME (@ms_cme) October 6, 2021
