COVID-19 prevention and multiple sclerosis management: The SAFE pathway for the post-peak

Buonomo, Antonio Riccardo; Morra, Vincenzo Brescia; Zappulo, Emanuela; Lanzillo, Roberta; Gentile, Ivan; Montella, Emma; Triassi, Maria; Palladino, Raffaele; Moccia, Marcello

doi:10.1016/j.msard.2020.102282

Cited by 11 publications

(14 citation statements)

References 18 publications

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“…One group has proposed the SAFE protocol based on the Italian experience during COVID-19. This includes standardizing protocols for Screening [for COVID-19 associated symptoms], Access [to MS care], Face [coverings] and E-health [options for MS] ( Bunonomo et al., 2020 ). A “massive investment” for dedicated resources and human and technological services has been called for in the case of neurorehabilition in particular, even while recognizing that remote evaluations have clear limitations ( Leocani et al., 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

Vogel

Schmidt²,

Loud³

et al. 2020

Multiple Sclerosis and Related Disorders

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Background: People with multiple sclerosis (PwMS) experienced changes in health behaviors and access to MS care due to the COVID-19 pandemic. The USA has the highest recognized number of Covid19 infections globally. The extent of the impact of COVID-19 has not been well characterized in large samples of PwMS to date. The MS patient perspective on COVID-19 would complement the physician-reported cases of MS and COVID-19 in the literature. Methods: A cross-sectional survey of adult PwMS was performed online, using the U.S.-based patient-powered iConquerMS™ platform, in April 2020. Results: There were 1,145 respondents (response rate: 20%). 1,019 had a diagnosis of MS and responded completely (average age: 54.2 years, range: 20-81; 79% female; 64% relapsing remitting, 22% secondary progressive, 12% primary progressive; 88% in the USA). 748 (73%) used a DMT in the last year, primarily higherefficacy therapies: ocrelizumab (n=238), dimethyl fumarate (n=85), fingolimod (n=80). The most frequent comorbidities were depression (41%), hypertension (26%), and asthma (12%). Women were more worried than men about COVID-19 (p=0.001); non-white-identifying PwMS believed it was a greater danger to their health than white-identifying PwMS (p=0.002). Through the continuum of symptoms to care, 61% of PwMS (n=617) reported symptoms associated with COVID-19, 39% (n=395) knew someone exposed to COVID-19, 4% (n=38) were aware of a personal COVID-19 exposure, 13% (n=128) wanted testing for COVID-19 but could not access it, and 4% (n=43) were tested. Specific to their MS care, 64% (n=650) canceled a medical visit, 22% (n=222) canceled a neurologist visit, 11% (n=112) canceled an MRI, 21% (n=212) canceled a laboratory test, and 10% (n=98) changed their DMT in some way due to COVID19 including 65 delaying at least one dose. 37% (n=382) had a telehealth visit due to COVID-19. 37% of PwMS (n=374) experienced employment changes, most commonly working from home (n=194) and having work hours reduced (n=65) while 32 lost their jobs. Of the 7 cases who tested positive for COVID-19 (<1% of participants) (5 female; age range: 29-64 years), DMTs included dimethyl fumarate (n=2), ocrelizumab (n=1), rituximab (n=1), and a clinical trial drug (n=1). Conclusions: A majority of people with MS reported interruptions to their MS care along the MS care pathway alongside limited access to COVID-19 testing. Postponements and delays in care were common with 10% of participants reporting a change in their DMT administration. Less than 1% of this self-referred convenience online cohort had a positive test for COVID-19 although more than half reported symptoms that are associated with COVID-19. Organization, 2020) By mid-April, SARS-CoV-2 was detected in 185 countries, had infected at least 19 million people worldwide, and linked to >700,000 deaths. (Johns Hopkins University, 2020) Multiple sclerosis (MS) affects more than three-quarters of a million adults in the U.S.A. People with MS (PwMS) on higher efficacy disease modifying therapies (DMTs) may be at an incr...

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

Vogel

Schmidt²,

Loud³

et al. 2020

Multiple Sclerosis and Related Disorders

View full text Add to dashboard Cite

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“…It is currently unknown whether lymphopenia represents a risk factor for morbidity and mortality from COVID-19, or is actually beneficial by preventing the abnormal systemic immune response ( Parrotta et al., 2020 , Minotti et al., 2020 ). We have shown that MS patients with lymphopenia following cladribine treatment can develop mild or no symptoms from COVID-19, suggesting that lymphopenia is not necessarily a risk factor for worse disease outcomes, and immunosuppressive DMTs do not necessarily need to be suspended or delayed in the course of the current pandemic ( Giovannoni et al., 2020 , Buonomo et al., 2020 ). This consideration applies to both a young, newly-diagnosed, drug-naïve patient and to an adult patient with comorbidities and long standing history of MS clinical features and treatments.…”

Section: Discussionmentioning

confidence: 99%

“…We acknowledge that the generalizability of our considerations is limited, deriving from the observation of two isolated cases, but we believe that they represent valuable hints needing confirmation in larger populations. Also, while COVID-19 testing for all MS patients dosing/redosing immunosuppressive DMTs has been suggested ( Buonomo et al., 2020 ), there are differences between healthcare systems and local protocols that should be accounted for when translating our considerations in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Mild or no COVID-19 symptoms in cladribine-treated multiple sclerosis: Two cases and implications for clinical practice

Angelis

Petracca

Lanzillo

et al. 2020

Multiple Sclerosis and Related Disorders

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Background The use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) could affect COVID-19 outcomes by modulating the immune response, which, in turn, might favor viral replication and/or confer protection from COVID-19 induced inflammatory response Case report We report on two MS patients treated with cladribine, with heterogeneous demographics and clinical features, who developed mild or no symptoms from COVID-19 and produced anti-SARS-CoV-2 antibodies, notwithstanding low lymphocyte levels. Implications Benign COVID-19 clinical course and anti-SARS-CoV-2 antibody production can occur in MS patients with lymphopenia, suggesting the possibility to respond to COVID-19 vaccination, once available, in this vulnerable population.

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“…Additionally, people with MS have higher prevalence of a number of comorbidities (e.g., cardiovascular) when compared with the general population [ 3 , 4 ]. Not least, the use disease-modifying treatments (DMTs), causing different degrees of systemic immunosuppression, might further affect the possibility of preventing and responding to the infection [ 5 ]. In line with this, healthcare providers and policy makers have immediately advised people with MS to self-isolate, and the use of immunomodulatory and immunosuppressive DMTs has been postponed [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of SARS-CoV-2 Antibodies in Multiple Sclerosis: The Hidden Part of the Iceberg

Capasso

Palladino

Montella

et al. 2020

JCM

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Background. We compared the prevalence of SARS-CoV-2 IgG/IgM in multiple sclerosis (MS), low-risk, and high-risk populations and explored possible clinical correlates. Methods. In this cross-sectional study, we recruited MS patients, low-risk (university staff from non-clinical departments), and high-risk individuals (healthcare staff from COVID-19 wards) from 11 May to 15 June 2020. We used lateral flow immunoassay to detect SARS-CoV-2 IgG and IgM. We used t-test, Fisher’s exact test, chi square test, or McNemar’s test, as appropriate, to evaluate between-group differences. Results. We recruited 310 MS patients (42.3 ± 12.4 years; females 67.1%), 862 low-risk individuals (42.9 ± 13.3 years; females 47.8%), and 235 high-risk individuals (39.4 ± 10.9 years; females 54.5%). The prevalence of SARS-CoV-2 IgG/IgM in MS patients (n = 9, 2.9%) was significantly lower than in the high-risk population (n = 25, 10.6%) (p < 0.001), and similar to the low-risk population (n = 11, 1.3%) (p = 0.057); these results were also confirmed after random matching by age and sex (1:1:1). No significant differences were found in demographic, clinical, treatment, and laboratory features. Among MS patients positive to SARS-CoV-2 IgG/IgM (n = 9), only two patients retrospectively reported mild and short-lasting COVID-19 symptoms. Conclusions. MS patients have similar risk of SARS-CoV-2 infection to the general population, and can be asymptomatic from COVID-19, also if using treatments with systemic immunosuppression.

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COVID-19 prevention and multiple sclerosis management: The SAFE pathway for the post-peak

Cited by 11 publications

References 18 publications

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

Impact of the COVID-19 pandemic on the health care of >1,000 People living with multiple sclerosis: A cross-sectional study

Mild or no COVID-19 symptoms in cladribine-treated multiple sclerosis: Two cases and implications for clinical practice

Prevalence of SARS-CoV-2 Antibodies in Multiple Sclerosis: The Hidden Part of the Iceberg

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