Potential use of the SARS-CoV-2 monoclonal antibody sipavibart in people with multiple sclerosis: definition of different patient archetypes from an Italian expert group perspective

• Published in: Journal of neurology Vol. 272; no. 7; p. 446
• Main Authors: Zanetta, Chiara, Gasperini, Claudio, Amato, Maria Pia, Centonze, Diego, Gallo, Paolo, Patti, Francesco, Riva, Agostino, Filippi, Massimo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2025; Springer Nature B.V
• Subjects: Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antiretroviral drugs; CD20 antigen; Cladribine; Comorbidity; COVID-19; COVID-19 - immunology; COVID-19 - prevention & control; COVID-19 vaccines; Disease prevention; Female; Humans; Immunization; Immunocompromised Host; Immunomodulation; Italy; Male; Medicine; Medicine & Public Health; Monoclonal antibodies; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - drug therapy; Multiple Sclerosis - epidemiology; Multiple Sclerosis - immunology; Neurology; Neuromodulation; Neuromyelitis; Neuroradiology; Neurosciences; Patients; Pediatrics; Pre-Exposure Prophylaxis - methods; Prophylaxis; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Short Commentary; Steroid hormones; Vaccination; Italy; Pre-exposure profilaxis; Sipavibart; Multiple sclerosis; SARS-CoV-2
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-025-13188-9

Introduction Immunocompromised people, including people with MS (PwMS) remain at increased risk of severe COVID-19 outcomes, highlighting how this population needs additional preventive measures beyond current vaccination. Seven neurologists with experience in the MS field and one infectivologist discussed the use of COVID-19 pre-exposure prophylaxis (PrEP) in PwMS, identifying patients’ archetypes for PrEP with the monoclonal antibody sipavibart. Methods The following topics were discussed: description of the current SARS-CoV-2 infection scenario; identification of the characteristics of the fragile patient; identification of the ideal candidate for PrEP with sipavibart. The recommendations were then produced accordingly. Results Vaccination remains a crucial preventive measure for COVID-19. Age, male sex, and comorbidities are associated with severe outcomes among patients with MS. MS-specific risk factors include higher disability, a progressive disease course, a recent administration of steroids and the treatment with anti-CD20 agents, S1P receptor modulators, cladribine, and anti-CD52 antibodies. Pediatric patients and subjects with neuromyelitis optica spectrum disorder should also be considered fragile subjects. Subjects who could benefit from PrEP include: PwMS who present risk factors similar to the general population or who present disease-specific risk factors, non-vaccinated PwMS, and PwMS under S1P receptor modulators, anti-CD20 agents, alemtuzumab or cladribine and who present at least one risk factor similar to the general population or one disease-specific risk factor. Discussion Subjects with general or disease specific risk factors for severe infections, patients treated with S1P receptor modulators, anti-CD20 agents, alemtuzumab or cladribine, pediatric patients, and pregnant women with MS could represent the ideal candidates for PrEP with sipavibart.