Antibody response elicited by the SARS-CoV-2 vaccine booster in patients with multiple sclerosis: Who gains from it?

Background and purpose: Although two doses of COVID-19 vaccine elicited a protective humoral response in most persons with multiple sclerosis (pwMS), a significant group of them treated with immunosuppressive disease-modifying therapies (DMTs) showed less efficient responses.Methods: This prospective multicenter observational study evaluates differences in immune response after a third vaccine dose in pwMS.Results: Four hundred seventy-three pwMS were analyzed. Compared to untreated patients, there was a 50-fold decrease (95% confidence interval [CI]=14.3-100.0, p < 0.001) in serum SARS-CoV-2 antibody levels in those on rituximab, a 20-fold decrease (95% CI=8.3-50.0, p < 0.001) in those on ocrelizumab, and a 2.3-fold decrease (95% CI = 1.2-4.6, p = 0.015) in those on fingolimod. As compared to the antibody levels after the second vaccine dose, patients on the anti-CD20 drugs rituximab and ocrelizumab showed a 2.3-fold lower gain (95% CI = 1.4-3.8, p=0.001), whereas those on fingolimod showed a 1.7-fold higher gain (95% CI = 1.1-2.7, p = 0.012), compared to patients treated with other DMTs.Conclusions: All pwMS increased their serum SARS-CoV-2 antibody levels after the third vaccine dose. The mean antibody values of patients treated with ocrelizumab/rituximab remained well below the empirical "protective threshold" for risk of infection identified in the CovaXiMS study (>659 binding antibody units/mL), whereas for patients treated with fingolimod this value was significantly closer to the cutoff

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Piranesi's lost book, 1757-1758

Il libro perduto di Piranesi, 1757-58 Disperse tra lettere private e fogli a stampa, oggi disseminati tra Francia e Regno Unito, l'autore ha pazientemente raccolto in più di venti anni di ricerca alcune informazioni dalle quali emerge con certezza che, intorno al 1757-58, Piranesi stava lavorando intorno a un nuovo libro dedicato al solo Pantheon. Nel contributo si presenta quanto è ricostruibile di tale libro e, in via ipotetica, si illustrano i motivi per i quali Piranesi scelse infine di rinunciare al suo progetto editoriale. Il coinvolgimento, a vario titolo, di Giovanni Gaetano Bottari, Pierre Jean Mariette, padre Louis Avril e degli inglesi Thomas Hollis e Thomas Jenkins situa la vicenda nel contesto della Roma internazionale del momento; in Appendice è presentato il percorso delle lettere manoscritte e dei testi a stampa dei vari protagonisti, al fine di illustrare la diffusione delle informazioni relative a questo mancato libro di Piranesi, nonché più in generale alle critiche espresse all'estero sui restauri allora in corso nel Pantheon. In questo contesto, finora inedito, risulta evidente il ruolo della censura pontificia che, oltre a impedire l'uscita del libro di Piranesi, ha limitato fortemente la diffusione di ogni informazione al riguardo del rinnovamento di uno dei maggiori monumenti romani

Luigi Canina: architetto e archeologo

Nel numero monografico, dedicato al rapporto tra architetti e archeologi, l'autore presenta le opere e gli scritti di Luigi Canina

Que faire des ruines? Le temple rond du Forum Boarium en 1810

Tra la metà del Settecento e i primi decenni del secolo successivo, il piccolo tempio rotondo nel Foro Boario è stato oggetto di più riflessioni e, infine, di un restauro. Grazie alla pluralità delle voci raccolte, una vicenda tutto sommato prevedibile - che vede i monumenti romani via via valorizzati a scapito delle fasi storiche successive - permette di restituire le complessità di ogni operazione del genere

Tra Francesco Milizia e Antonio Canova: l'architettura a Roma intorno al 1800

L'autore mette in evidenza l'influenza esercitata dal teorico Francesco Milizia su Antonio Canova, al fine di individuare i caratteri dell'architettura neoclassica intorno al 1800

Milizia, una lettera e l'apparato funebre per Carlo III di Spagna.

Attraverso la rilettura delle fonti d'epoca, si mette in evidenza il ruolo avuto da Francesco Milizia nell'ideare un apparato funebre, ove il cenotafio aveva la forma di un tempio dorico