COVID-19 outcomes in MS

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>To report outcomes on patients with multiple sclerosis (MS) and related disorders with coronavirus disease 2019 (COVID-19) illness.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>From March 16 to April 30, 2020, patients with MS or related disorders at NYU Langone MS Comprehensive Care Center were identified with laboratory-confirmed or suspected COVID-19. The diagnosis was established using a standardized questionnaire or by review of in-patient hospital records.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We identified 76 patients (55 with relapsing MS, of which 9 had pediatric onset; 17 with progressive MS; and 4 with related disorders). Thirty-seven underwent PCR testing and were confirmed positive. Of the entire group, 64 (84%) patients were on disease-modifying therapy (DMT) including anti-CD20 therapies (n = 34, 44.7%) and sphingosine-1-phosphate receptor modulators (n = 10, 13.5%). The most common COVID-19 symptoms were fever and cough, but 21.1% of patients had neurologic symptom recrudescence preceding or coinciding with the infection. A total of 18 (23.7%) were hospitalized; 8 (10.5%) had COVID-19 critical illness or related death. Features more common among those hospitalized or with critical illness or death were older age, presence of comorbidities, progressive disease, and a nonambulatory status. No DMT class was associated with an increased risk of hospitalization or fatal outcome.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Most patients with MS with COVID-19 do not require hospitalization despite being on DMTs. Factors associated with critical illness were similar to the general at-risk patient population. DMT use did not emerge as a predictor of poor COVID-19 outcome in this preliminary sample.</jats:p></jats:sec>

Evaluating the perspective of patients with MS and related conditions on their DMT in relation to the COVID-19 pandemic in one MS centre in Australia

“…A pharmacovigilance case-series reported 100 patients with multiple sclerosis treated with Ocrelizumab with either confirmed (n=74) or suspected (n=26) COVID-19 infection in whom 26 were hospitalised, 5 developed critical illness, but no patients died ( Hughes et al., 2020 ). In an observational study evaluating outcomes of 76 actively treated patients with multiple sclerosis with confirmed (n=37) or suspected (n=39) COVID-19, a slightly higher rate (34 of 65 patients who were on DMT's) of patients were receiving anti-CD20 therapy compared to the centre's overall proportion of patients on such therapy, though the significance of this finding was uncertain, and overall hospitalisation (24%) and mortality rates (7%) were comparable to the general population ( Parrotta et al., 2020 ).…”

“…A pharmacovigilance case-series reported 100 patients with multiple sclerosis treated with Ocrelizumab with either confirmed (n=74) or suspected (n=26) COVID-19 infection in whom 26 were hospitalised, 5 developed critical illness, but no patients died (Hughes et al, 2020). In an observational study evaluating outcomes of 76 actively treated patients with multiple sclerosis with confirmed (n=37) or suspected (n=39) COVID-19, a slightly higher rate (34 of 65 patients who were on DMT's) of patients were receiving anti-CD20 therapy compared to the centre's overall proportion of patients on such therapy, though the significance of this finding was uncertain, and overall hospitalisation (24%) and mortality rates (7%) were comparable to the general population (Parrotta et al, 2020). That none of our patients had contracted COVID-19 may have reflected the overall low incidence in Melbourne and Victoria Australia during the study period, though notwithstanding this, was in keeping with the results of a study of 1,836 patients with MS and 3,128 patients with NMOSD from 10 centres across China, where no increased risk COVID-19 could be detected despite 61.9% of patients being on DMT's, including 108 patients on Rituximab, with only 2 confirmed cases (Fan et al, 2020).…”

“…Overall, almost a third of our cohort were concerned with worsened COVID-19 outcomes as a result of their DMT. Factors associated with COVID-19 severity in patient with MSincluded age, progressive disease course and a higher degree of disability in a series of 40 PCR-confirmed cases, but not DMT use ( Chaudry et al., 2020 ), whilst older age, non-ambulatory status, progressive disease and medical comorbidities in a series of 76 confirmed or suspected cases were risk factors for hospitalisation ( Parrotta et al., 2020 ). Similarly, increasing age, male sex, EDSS score, a progressive disease course, medical comorbidities and obesity, but not DMT exposure, were found to be associated with an increased risk of severe COVID-19 in a multi-centre observational cohort study from France ( Louapre et al., 2020 ).…”

Nervenschäden schon bei milden COVID-19-Verläufen?

“…Eine größere französische Analyse konnte diese Befürchtungen jedoch entkräften: Vielmehr waren ein hoher EDSS-Wert, ein hohes Alter und Begleiterkrankungen mit einem ungünstigen Verlauf verbunden. Darauf deutet nun auch eine Analyse aus Italien von 76 MS-Kranken mit COVID-19 [5]. Immerhin die Hälfte erhielt eine lymphozytendepletierende Behandlung.…”

N2 in the time of COVID-19

“…This issue of Neurology® Neuroimmunology & Neuroinflammation reflects the impact of the COVID-19 pandemic with 15 studies related to inflammatory or autoimmune neurologic complications in patients with this disease, including Guillain-Barré syndrome, CNS inflammatory disorders, and several studies addressing the risk of COVID-19 in patients with neuromyelitis optica spectrum disorders (NMOSD) or multiple sclerosis (MS). Among the latter, a study conducted in New York by Parotta et al 1 included 72 patients with MS (55 relapsing and 17 progressive) or related disorders (4 patients) and confirmed (37 patients) or suspected COVID-19 illness. Most patients did not require hospitalization despite being on disease-modifying therapies; factors associated with critical illness were similar to those of the general at-risk patient population.…”