Positive Health Online

Abstract

MYCKO, 1 Department of Neurology, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland, Warszawska 30, 10-082 Olsztyn, Poland. marcin.mycko@uwm.edu.pl opines that further research into the different role of B cells during autoimmune demyelination should yield better, safer strategies to control the encephalitogenic process in the multiple sclerosis (MS) drugs portfolio.

Background

Research into the mechanisms of autoimmune demyelination have highlighted B cells in this process. Therapies targeting this population were a recent addition to the multiple sclerosis (MS) drugs portfolio. The SARS-CoV-2 pandemic and the risk of severe COVID-19 have challenged the safety of B cell depletion in MS patients.

Methodology

Selective depletion of B cells by monoclonal antibodies as monotherapy in MS has been shown to profoundly suppress disease activity among relapsing-remitting MS patients. Furthermore ocrelizumab, a humanised anti-CD20 monoclonal antibody, was the first licensed therapy in primary progressive MS. Based on the concept of the role of B cells in MS, many therapeutic approaches are emerging as novel ways to treat autoimmune demyelination. However, during the SARS-CoV-2 pandemic, a conservative approach toward limiting immune suppression in MS patients has been proposed.

Results

Clinical implications: Emerging evidence does not support the notion of increased susceptibility among MS patients to the SARS-CoV-2 infection, or any predisposition toward greater severity of COVID-19. This also does not appear to be the case for MS patients undergoing B cell depletion therapies. Thus, any decision to withhold immune suppression in MS patients during the SARS-CoV-2 pandemic is probably incorrect. MS therapeutic decision-making should focus on the danger of poorly controlled autoimmune demyelination rather than perceived risks from COVID-19.

Conclusion

The current pandemic highlights the need to develop more selective and safer methods of immunomodulation in MS. B cells represent several functionally different populations. Further research into the different role of these cells during autoimmune demyelination should yield better, safer strategies to control the encephalitogenic process.

References

Marcin P Mycko  1. B cell targeting therapies in MS patients during the SARS-CoV-2 pandemic - when immunosuppression meets infection? Neurol Neurochir Pol.; 54(6):490-501. doi: 10.5603/PJNNS.a2020.0083. Epub 2020 Oct 19. 2020.