(E) For patients without immunotherapy (= 127), there was no significant difference of ARR during the pandemic and 1 or 2 2 years before the pandemic. the pandemic, 42.1% of the 361 patients and 65.0% of the 234 patients on immunotherapies were exposed to teriflunomide. Compared to patients who didn’t receive treatment, patients exposed to DMTs had significantly lower levels of neutrophils ( 0.01) and immunoglobulin G ( 0.01), and patients exposed to immunosuppressants had significantly RS 127445 lower levels of immunoglobulin G ( 0.05). Over 80% of our patients followed RS 127445 effective protective measures and none of the 361 MS patients in our cohort contracted COVID-19. Patients whose treatment was disrupted RS 127445 had a significantly higher annualized relapse rate (ARR) during than before the pandemic ( 0.01), while the ARR of patients with continuous treatment or without treatment remained unchanged. During the pandemic, the risk of MS attack due to treatment disruption possibly outweighs the risk of COVID-19 infection under preventive measures, and MS treatment maintenance might be necessary. = 152), interferon 1-b (= 18), and fingolimod (= 8), while 56 (15.5%) patients were treated with immunosuppressants, including mycophenolate mofetil (= 42), azathioprine (= 11), cyclosporine (= 1), cyclophosphamide (= 1), and tacrolimus (= 1) (Table 1). Table 1 Demographic, clinical characteristics, and behavior of patients in the pandemic. = 152), IFNB (= 18), fingolimod (= 8), and immunosuppressants (= 56). The median (IQR) duration of treatment was 1.0 (0.5C3.0) years. One hundred and fifty-nine patients with sufficient baseline documentation in the MSNMOBase were not included in the final analysis. We compared the baseline characteristics of these patients to the 361 patients included in final analysis and found no significant difference in age, gender, disease duration, EDSS score at last follow-up, immunotherapies, treatment duration, and ARR before treatment. Immune Status, Preventive Approaches, and COVID-19 Morbidity in MS Cohorts The complete blood cell (CBC) counts, lymphocyte subsets, and immunoglobulin levels within 6 months of the start of the pandemic were recorded in 272, 247, and 238 patients, respectively. Detailed median (range) levels of different immune cells and immunoglobulins in patients exposed to DMTs, patients exposed to immunosuppressants, and patients without immunotherapy are shown in Figure 3. Patients exposed to teriflunomide had the lowest median (range) levels of CD19+ B cells [183.0 (40.0C1,195.0)/l], CD3+ T cells [1,307.0 (371.0C4,950.0)/l], CD4+ T cells [713.5 (38.8C3,774.0)/l], PRKACA CD8+ T cells [491.0 (2.1C1,525.0)/l], white RS 127445 blood cells [5.91 (3.51C19.36)/109/L], neutrophil granulocytes [3.59 (1.49, 150.00)/109/L], and total lymphocyte counts [1.82 (0.75C6.52)/109/L]. Patients exposed to interferon 1-b had the lowest median (range) level of CD16+CD56+ NK cells [190.0 (144.0, 714.0)/l] while patients exposed to immunosuppressants had the lowest median (range) level of immunoglobin G [8.75 (6.09, 19.66) g/L]. Open in a separate window Figure 3 Immune status of MS patients on immunotherapies in COVID-19 pandemic. (A) T/B lymphocyte subsets of MS patients on immunotherapies in COVID-19 pandemic, categorized according to DMTs. (B) White blood cells, neutrophil granulocytes, and total lymphocyte counts of MS patients in COVID-19 pandemic, categorized according to DMTs. (C) Immunoglobin levels of MS patients in COVID-19 pandemic, categorized according to DMTs. CBC, Complete Blood Count; COVID-19, coronavirus disease 2019; DMTs, Disease-Modifying Therapies; Ig, Immunoglobin; MS, Multiple Sclerosis; N, neutrophil granulocytes; NK cells, Natural Killer cells; TLC, Total Lymphocyte Counts; WBC, White Blood Cells. In patients exposed to DMTs, compared with interferon 1-b, patients exposed to teriflunomide had significantly lower median (range) levels of CD19+ B cells [315.0 (204.0, 512.0)/l vs. 183.0 (40.0C1,195.0)/l, = 0.017] and CD4+ T cells [1,001.0 (719.0, 1,255.0)/l vs. 713.5 (38.8C3,774.0)/l, = 0.026] while patients exposed to fingolimod had significantly lower median (range) levels of immunoglobin G [10.14 (9.44, 15.71) g/L vs. 8.80 (6.62, 10.09) g/L, = 0.011]. The median (range) levels of CD3+ T cells, CD8+ T cells, CD16+ CD56+ NK cells, white blood RS 127445 cells, neutrophil granulocytes, and total lymphocyte counts had no significant difference among patients exposed to the three different DMTs. Patients exposed to DMTs had significantly lower median (range) levels of neutrophils than patients without immunotherapy [3.58 (1.49C13.46)/109/L vs. 4.45 (1.52, 16.50)/109/L, 0.01]. Compared with patients without immunotherapy, patients subjected to DMTs [9.43 (4.51C25.16) g/L vs. 10.39 (6.04C31.69) g/L, 0.01] and immunosuppressants [8.75 (6.09C19.66) g/L vs. 10.39 (6.04, 31.69) g/L, 0.05] had significantly lower median (range) degrees of immunoglobulin G (Table 2). Desk 2 Immune position of individuals with and without immunotherapy through the pandemic. 0.01) and 2.16 (1.66, 2.16) ( 0.01), respectively (Shape 4B)..