Multiple sclerosis management during the COVID-19 pandemic

Abstract

Background: People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. Objectives: To evaluate risk factors for COVID-19 susceptibility and describe the pandemic’s impact on healthcare delivery. Methods: Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d’Hebron-Centre d’Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. Results: There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Conclusion: Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption.

Incidence and Impact of COVID-19 in MS

“…The mean age of our patients was similar to that reported in a French study with 347 patients 3 and a study from New York city with 76 patients, 10 suggesting that patients with MS who are older and have more comorbidities undergo a stricter confinement. This hypothesis is supported by the association found between younger age of patients with COVID-19 with higher exposure to possible sources of infection, as reported in 2 large studies of MS conducted in Europe and the United States 11,12 and in a study of patients with rheumatic diseases treated with biological and synthetic diseasemodifying antirheumatic drugs carried out in Barcelona. 13 This fact, and more frequent medical consultation due to patients' concern of an increased risk associated with therapy, would explain the increased incidence of COVID-19 observed in our study.…”

Multiple Sclerosis Disease‐Modifying Therapies in the COVID‐19 Era

“…Dr Moss commented in his recent observational study that the main risk factor for developing suspected or confirmed COVID‐19 was a known history of exposure, highlighting the importance of standard infection prevention measures 4 . In patients who have been stable on a DMT for a prolonged period, delaying routine magnetic resonance imaging for disease surveillance might help to avoid exposure.…”

“…The panelists also acknowledged the indirect impacts of the COVID‐19 pandemic on MS patients. Dr Moss pointed out that 16% of patients at the Cleveland Clinic Mellen Center have had an interruption in rehabilitation services during the pandemic 4 . Many have also experienced increased stress, depressed mood, and decreased medical contact during the pandemic, reinforcing the need for clinicians to ask MS patients about other symptoms and medical screenings.…”

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

“…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 ].…”

“…In particular, asymptomatic carriers can transmit the virus in the absence of obvious symptoms and could be responsible for keeping SARS-CoV-2 circulating [ 12 ]. As such, studying the prevalence of SARS-CoV-2 IgG/IgM in MS can shed light on the risk of COVID-19 infection in relation to MS and/or to the use of some DMTs, on the amount of patients who are still susceptible to infection, and on the possibility of asymptomatic carriers in MS, and can also be used to plan clinical activities accordingly [ 5 , 8 , 13 , 14 , 15 ]. Thus, in the present study, we aim to: (1) evaluate the prevalence of SARS-CoV-2 IgG/IgM antibodies in asymptomatic MS patients, compared with populations at low-risk and high-risk of COVID-19 infections; and (2) explore possible correlates with demographics, clinical features, treatments, comorbidities, and laboratory findings.…”